THU0124 INFLUENCE OF AUTOIMMUNE VASCULITIS ON LUNG DISEASES IN RHEUMATOID ARTHRITIS – A POSTMORTEM CLINICOPATHOLOGIC STUDY OF 161 PATIENTS

Abstract

Background: Complications of rheumatoid arthritis (RA) may modify the clinical course and symptoms of allied disorders leading to missed diagnosis or late recognition of associated diseases. Objectives: The aim of this study was to determine the possible role of classic complications of RA: systemic autoimmune vasculitis (AV), AA amyloidosis (AAa), lethal cardiac insufficiency (CI) caused by endo-, myo- or pancarditis, with or without interstitial pneumonitis, furthermore lethal septic infection (SI) on prevalence and mortality of coexistent associated diseases: atherosclerosis (Ath), hypertension (HT), type 2 diabetes mellitus (DM), and tuberculosis (Tb) with miliary dissemination (mTb). Methods: 234 non- selected autopsy patients with RA were studied. RA was confirmed clinically according to the criteria of the ARA. The presence of AV, AAa, CI and SI was determined at autopsy and confirmed by a detailed review of extensive histological material. The prevalence and mortality of associated diseases Ath, HT, DM, Tb or mTb were determined and analyzed retrospectively, reviewing the clinical and pathological reports. The link between AV, AAa, CI or SI andAth, HT, DM, Tb or mTb was analyzed by (χ2) test. Results: RA was complicated by AV in 43 (18.4%), by AAa in 48 (20.5%), by CI in 15 (6.4%), and by lethal SI in 33 (14.1%) of 234 patients. RA associated with severe Ath in 106 (45.3%), with HT in 41 (17.5%), with DM in 41 (17.5%), with Tb in 28 (11.9%) and with mTb in 9 (3.8%) of 234 patients. As a basic disease Ath led to death in 61 (26.1% of 106), HT in 2 (0.9% of 41), DM in none (0% of 41) and Tb with mTb in 3 (1.3% of 28) of 234 patients. Tb without miliary dissemination was not lethal in our patient population. The statistical links (“p” values of significance) between complications of RA and prevalence or mortality of allied disorders are summarized in Table. (*asterisk indicates a negative value of associations’ coefficient with inverse relationship). Conclusion: The inverse correlations between AV, AAa, CI, SI andAth, HT, DM, Tb or mTb indicate that the prevalence and mortality of allied disorders were not influenced basically by the complications of RA. The consequently inverse and (in most cases) significant correlations between prevalence of AV, AAa, CI, SI and the prevalence and mortality of Ath show that these are independent entities in RA. The AV, AAa, CI and SI are the most important complications of RA, and are characterize severe forms of disease, mostly involving younger patients, with an earlier onset (without pronounced atherosclerosis); while Ath is basically an age dependent phenomenon, characteristically present in RA patients with advanced age. RA patients with Ath may represent a special group of RA, characterized by lower incidence of AV, AAa, CI or SI, and a better prognosis. Disclosure of Interests: None declared