The evaluation of psyciatric, cardiac and thyroid disorders associated in patients with rheumatoid arthritis

Introduction: Rheumatoid arthritis is a chronic systemic inflammatorydisease. Neuropsyciatric, cardiac and thyroidal involvement can be seen in RA asextraarticular signs.Psyciatric disorder and Cardiovasculer diseases (CVD) are commonly seen inRA and this situation increase the mortality and morbidity. Thyroidal dycfunction(TD) and autoimmüne thyroidal disease (ATD) are also seen in patients with RA.The aim of this study is to investigate left ventricular diyastolic functions,thyroidal functions and the frequency of psyciatric disorders in patients with RA.Methods: The study included 82 RA cases and 41 age- and sex-matchedhealthy volunteers as the control group. Psychiatric examinations of all cases of thepatient and control groups were performed according to DSM-IV criteria. HamiltonAnxiety Scale or Hamilton Depression Scale was applied to those who were foundto have psychiatric disorders.Thyroid hormones and thyroid autoantibodies were also evaluated and allpatients were classified as hypothyroid, hyperthyroid and euthyroid.Patients, with systemic disease that could affect cardiac function and hadhistory and psysical examination findings which suspected cardiac disease wereexcluded from RA patients group. Doppler-ECHO was applied to RA patients andhealthy controls; left venricular functions were determined.Results: Prevalence of psychiatric disorders was found to be 70.8% (n:58) inthe patient group and 7.3% (n:3) in the control group, and there was a significantdifference between groups (p<0.001). Of the RA patients, 41.5% (n:34) was foundto have depressive disorder, 13.4% (n:11) anxiety disorder and 15.9% (n:13) mixedanxiety-depressive disorder. In patients with anxiety disease duration was shorterthan the RA patient with depression (p<0.05). The disease duration was positivelycorrelate with the degree of depression and negatively correlate with the degree ofanxiety (r=0.341, p<0.05; r=-0.642, p<0.05, respectively).In RA patients we have found abnormalities of the left ventricular fillingcharacterised by a reduced E/A ratio (p<0.05) and an increased IsovolumicRelaxation Time (IVRT) (p<0.05). There were negative significant correlationbetween the age of patients and E/A ratio (r= -0.350, p<0.05); positive significantcorrelation between the age of patients and IVRT (r= 0.444, p<0.01). There wasno statistically significant correlation between other ECHO parameters andduration of disease and other laboratory data.The frequency of TD is 9.8% in RA patients and nobody had TD in healthycontrols. There was statistically significant between both groups (p<0.05). All TDpatients were female. Five of the patients were hypothyroid (6%) and four of thepatients were hyperthyroid (4.8%) in RA patients. The overall frequencies ofATD was 4.8% (n:4) in RA patients; frequency of ATD with TD in RA patientswere 44.4% .Conclusions: Results of our study suggest that prevalences of some psychiatricdisorders, mainly depressive disorder, increase in RA cases. When the clinicalpicture in RA cases becomes complicated with psychiatric disorders, someproblems at patients? adaptation and response to treatment are inevitably. RA casesshould be monitored for psychiatric disorders during follow-up.Left ventricular diastolic dysfunction was observed in RA patients withoutcardiac disorder symptoms and signs compared to the healthy controls. RA patientshave increased the risk of CVD due to diastolic dysfunction that increase with theage of patients independent of the duration of disease compared to the normalindividuals.The incidance of TD is increased in female RA patients. The risk of ATDdevelopment in female RA patients is increased. The early diagnosis of ATD can beestablished by thyroid hormones and thyroid autoantibodies measurements.Key Words: Rheumatoid Arthritis, Psychiatric Disorders, Cardiac Involvement,Thyroidal dysfunction