Abstract
Patients with rheumatoid arthritis (RA) have a significantly high risk of atrial fibrillation (AF). This study aimed to compare the absolute and relative changes in peripheral T cells in patients with RA who were also affected with and without AF. To help make an early diagnosis and prevent the initiation and progression of AF, the changes in the lymphocyte subsets were assessed in RA patients with and without AF. A propensity score matching (PSM) system (1:3) was used to perform a matched case-control study with 40 RA-AF cases and 120 RA controls. Changes in the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-citrullinated peptide antibody (ACPA), and rheumatoid factor (RF) were examined. The percentage and absolute number of T, B, natural killer (NK), T helper (Th)1, Th2, Th17, and T-regulatory (Treg) cells in the peripheral blood of patients with and without RA-AF were determined using flow cytometry. Univariate and multivariate analyses were performed to determine the association between peripheral lymphocytes and RA-AF. Demographic data, ESR, CRP, ACPA, and the percentage, as well as the absolute value of B, NK, Th2, and Treg cells, showed no significant differences between the propensity score-matched groups of RA and RA-AF. Meanwhile, the absolute number and percentage of Th1 cells, the absolute number of Th17 cells, the ratio of Th1/Treg, Th17/Treg, and RF were significantly higher in patients with RA-AF than those in the control groups (P < 0.05). Univariate and multivariate logistic regression analyses also revealed that the percentage of Th1 cells, the absolute number of Th17 cells, and the ratio of Th1/Treg were associated with a significantly higher risk of AF. This PSM study demonstrated that the incidence of AF was higher in RA patients with Th cell immunological derangements.
Highlights
Rheumatoid arthritis (RA), which affects 0.1%–2.0% of adults in industrialized countries, is an autoimmune, inflammatory, and multisystem disorder characterized by chronic synovitis, systemic inflammation, and autoantibodies, including the rheumatoid factor (RF) and anticitrullinated peptide antibody (ACPA) [1]
Screening according to the criteria selected, 747 patients with rheumatoid arthritis (RA) with information about age, sex, hypertension, coronary artery disease (CAD), stroke, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), ACPA, C-reactive protein (CRP), Tlymphocyte subsets, B-lymphocyte subsets, and natural killer (NK) cells were obtained from medical records
The inflammatory markers, ESR, CRP, and ACPA, did not significantly differ between the two groups (P > 0.05), but levels of RF were significantly higher in patients with RA-atrial fibrillation (AF) (Table 3)
Summary
Rheumatoid arthritis (RA), which affects 0.1%–2.0% of adults in industrialized countries, is an autoimmune, inflammatory, and multisystem disorder characterized by chronic synovitis, systemic inflammation, and autoantibodies, including the rheumatoid factor (RF) and anticitrullinated peptide antibody (ACPA) [1]. Cardiovascular disease (CVD) resulting from chronic inflammation plays a vital role in increasing the economic burden and mortality of patients with RA [2]. AF is associated with substantial morbidity, reduced quality of life (QOL), and increased mortality due to the combination of altered hemodynamics, progressive atrial and ventricular mechanical dysfunction, heart failure, and thromboembolic complications; AF is a major burden on the healthcare systems. A relationship between RA and AF has been defined, early identification and anti-inflammatory therapy that can effectively prevent CVD have not been developed. This is mainly due to the long-term and insidious impact of chronic inflammation on the atrial substrate and the fact that AF has been largely ignored in patients with RA. Immune derangement (especially T cells) in patients with RA results in AF
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