CORRELATION OF EPICARDIAL ADIPOSE TISSUE THICKNESS WITH DAS28 SCORE IN PATIENTS WITH RHEUMATOID ARTHRITIS AT A TERTIARY CARE HOSPITAL IN CHENNAI, INDIA

Abstract

Background: Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease strongly associated with premature cardiovascular disease (CVD) and excess cardiovascular mortality. Epicardial adipose tissue (EAT), a metabolically active visceral fat depot in direct contact with the myocardium and coronary vessels, has emerged as a promising imaging biomarker of subclinical cardiovascular risk. However, its relationship with disease activity in RA remains under-explored in South Asian populations. Objective: To compare echocardiographic EAT thickness between patients with RA and healthy controls, and to evaluate its correlation with disease activity as assessed by the Disease Activity Score in 28 joints (DAS28). Methods: This hospital-based, case–control study was conducted at Sree Balaji Medical College and Hospital, Chennai, between June 2023 and June 2024. Forty patients (aged 18–40 years) with stable RA diagnosed according to the revised American College of Rheumatology (ACR) criteria and forty age- and sex-matched healthy controls were recruited. Individuals with traditional cardiovascular risk factors, coronary artery disease, or other systemic conditions influencing EAT were excluded. EAT thickness was measured on the free wall of the right ventricle using 2D transthoracic echocardiography from the parasternal long-axis view at end-diastole. Disease activity was quantified using the DAS28-ESR. Comparisons were made using independent-samples t tests and one-way ANOVA; correlations were assessed with Pearson’s coefficient. A p-value <0.05 was considered statistically significant. Results: The mean EAT thickness was significantly greater in patients with RA than in controls (5.76 ± 1.17 mm vs. 3.84 ± 0.69 mm; p<0.001). Among patients with RA, 10% were in remission, 35% had low, 32.5% had moderate, and 22.5% had high disease activity. EAT thickness increased progressively across disease activity categories, from 4.23 ± 0.31 mm in remission to 7.51 ± 0.44 mm in the high-activity subgroup (p<0.001). No significant difference in EAT was observed by disease duration (p=0.612) or treatment status (p=0.25). Conclusion: Patients with RA have significantly greater EAT thickness than healthy controls, and EAT thickness correlates directly with DAS28-defined disease activity. Two-dimensional echocardiographic measurement of EAT is a simple, low-cost, and non-invasive tool that may be integrated into routine cardiovascular risk stratification of patients with RA and may guide the earlier and more intensive use of disease-modifying therapy.