Associação de aspectos nutricionais e inflamatórios com remodelação ventricular em pacientes portadores de artrite reumatoide

• Ano de defesa: 2017
• Autor(a) principal: Baccaro, Antonio [UNESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Estadual Paulista (Unesp)
• Palavras-chave em Português: Artrite reumatoide; Remodelação cardíaca; Padrões de geometria; Composição corporal; Metaloproteases; Rheumatoid arthritis; Cardiac remodeling; Geometry patterns; Body composition; Metalloproteases
• Link de acesso: http://hdl.handle.net/11449/151958

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects not only joints, but also other organs, such as the heart. Systemic inflammation plays a fundamental role in the development of joint and extraarticular involvement. Thus, there is an increased risk for coronary disease in patients with RA. Direct heart involvement can be triggered by the process of cardiac remodeling, such as hypertrophy and changes in cardiac geometry, which can go years without causing symptoms. Another particular feature of AR and also related to chronic inflammation is the fact that they present a body composition with a phenotype more focused on being overweight, but with the possibility of having reduced muscle mass. Obesity, by itself, already raises the risk for cardiac involvement, however, little is known about the participation of body composition variables and some inflammatory markers in the cardiac remodeling of RA patients. Objectives: To evaluate whether body composition and inflammation variables, evaluated by metalloptreteaases (MMP-2 and MMP-9), are associated with remodeling and cardiac function. Methodology: A total of 71 patients with RA underwent clinical, anthropometric evaluation of the body composition by bioimpedance and dual emission X-ray densitometry, cardiac evaluation by transthoracic echocardiography, evaluation of inflammatory activity by DAS-28 and dosage of metalloprotease activity. Logistic and linear regression were performed to evaluate the association of variables with ventricular remodeling. These equations were adjusted by factors known to influence cardiac remodeling, such as hypertension, DAS-28, age, sex. Results: Most of the patients are female, on average they have mild disease activity and are overweight, with a high frequency of hypertension. In relation to nutritional diagnoses, 90% had a percentage of fat above normal, 20% had fat percentage above normal and lean mass lower than P25%, and 14.6% presented sarcopenia, the ratio between intracellular and extracellular water suggest hypervolemia. When evaluating the patients according to the activity of the disease, it is observed that MMP-9 is higher in patients with moderate activity and patients with disease in mild activity have higher fat mass. BMI, sarcopenia, percentage of fat above normal and lean mass below P25% did not explain ventricular remodeling. The lean mass assessed by DEXA was associated with a greater relative thickness of the wall and ventricular mass, but fat was not associated with these outcomes. MMP-9 increased by 3.4 times the risk for increased PRS. Conclusion: The probable association between lean body mass and heart mass is probably due to the greater body mass of these patients. The available methods do not allow the evaluation of water isolated from muscle mass. MMP-9 is one of the most studied markers in the joints, but it is perceived that its serum concentration could also be associated with extracardiac outcomes.