A relação entre corticoterapia, risco cardiovascular e níveis de mieloperoxidase em pacientes com artrite reumatóide

Abstract

Introduction: Rheumatoid arthritis is an inflammatory disease characterized by symmetrical peripheral polyarthritis. The prevalence rate found in the world population ranges from 0.5% to 1.0%, affecting mostly women with a higher number of patients between 30 and 50 years of age. The diagnosis is made associating clinical symptoms and signs, laboratory and r-ray findings. In the presence of extra-articular manifestations, the morbidity and severity of the disease increases and may reduce life expectancy. Glucocorticoid administration is used to treat this condition and may result in side effects that are related to cardiovascular risk. Objective: Establish the relation between cardiovascular risk, glucocorticoid treatment and myeloperoxidase in rheumatoid arthritis patients. Material and Methods: A unicentric cross-sectional study including 59 male and female volunteers with rheumatoid arthritis receiving treatment at Regional University Hospital of Campos Gerais. Subjects were divided into two groups: using glucocorticoids (n = 39) and without glucocorticoids (n = 20). The volunteers underwent clinical evaluation and physical examination. Blood samples were taken for different biochemical and immunological tests. The following surveys were asked: Beck's depression inventory; SF-36 and Health Assessment Questionnaire, to assess depression, quality of life and functional status of individuals, respectively. Statistical analysis was performed using Student's t-test and non-parametric Mann-Whitney test. Logistic regression was performed to assess cardiovascular risk. The significance level was 5% (α = 0.05). Calculations were performed using the Statistical Package for the Social Science (SPSS®) version 21.0. Results: There has been a significant difference between groups in blood glucose values (p = 0.012). When we assessed cardiovascular risk using the predictors of glucocorticoid dose, time of glucocorticoid use, myeloperoxidase, and C-reactive protein together, these were responsible for significantly predicting cardiovascular risk (p = 0.015). A significant relation between the predictor variable myeloperoxidase alone was also demonstrated (p = 0.037). Significant difference was observed between the groups in the physical aspects domain of the SF-36 survey (p = 0.004). Discussion: Blood glucose values differences can be explained by the different percentage of diabetic patients in the groups. Myeloperoxidase may be an important predictor of cardiovascular risk among individuals with rheumatoid arthritis, and further studies are needed to effectively use it as a biomarker for this purpose. Among the systemic side effects of corticosteroid therapy there are alterations in the physical aspects of the individual, seeing in individuals of the studied groups, and may be an important factor indirectly related to cardiovascular risk. Conclusion: Myeloperoxidase seems to be an important predictor of cardiovascular risk in patients with rheumatoid arthritis. Corticosteroid therapy can affect life quality of individuals regarding physical aspects, and may indirectly lead individuals to greater chances of cardiovascular disease.