Value of tumor necrosis factor-alpha and high-sensitive cardiac troponin-I as early predictors of subclinical atherosclerosis and their relation to disease activity in patients with rheumatoid arthritis:
A case-control study

The Egyptian Journal of Immunology
Volume 30 (3), July, 2023
Pages: 82 – 91.
Eman M. Ibrahem¹, Nabawia, M. Tawfik¹, Refaat F. Abdel-Aal¹, Ehab M. Moussa2, Azza M. Ezz-Eldin3, and Sabrin R. Mahmoud¹
1Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.

2Department of Diagnostic Radiology, Faculty of Medicine, Assiut University, Assiut, Egypt.

3Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.

Corresponding author:
Sabrin R. Mahmoud, Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.



Patients with rheumatoid arthritis (RA) have a higher risk of cardiovascular disease (CVD) compared to the general population, which leads to increased morbidity and mortality. Inflammation is the key in RA and CVD. Our study aimed to refine cardiovascular (CV) risk assessment in RA patients by using carotid intima-media thickness (cIMT) as a marker of subclinical atherosclerosis. We also explored whether proinflammatory cytokines represented by tumor necrosis factor-alpha (TNF-α) and high-sensitivity cardiac troponin I (hs-cTnI), a biomarker of myocardial injury, could be correlated in RA patients. The study included 80 RA patients and 80 control subjects. TNF-α and hs-cTnI levels were measured. Subclinical atherosclerosis was evaluated by cIMT by means of carotid ultrasound. Disease activity score 28 (DAS28) was used to evaluate disease activity. hs-cTnI and TNF-α serum levels were higher in RA patients compared to controls (p=0.001). There was a significant difference in the median of cIMT between cases and controls (median (IQR) 0.9 (0.2) for cases, 0.7 (0.1) for controls, (p=0.001). A significant correlation was found between the level of TNF-α and hs-cTnI (p=0.002). Also, there was a significant correlation between the cIMT level and TNF-α and hs-cTnI (p=0.003 and p=0.002, respectively). Significant correlation was found between cIMT, TNF-α, and hs-cTnI in relation to the DAS28 score (p<0.001, p<0.001, and p=0.001, respectively). In conclusion, patients with RA are more likely to develop subclinical atherosclerosis, as reflected in increased cIMT.  Higher levels of hs-cTnI in RA patients may correlate with the presence of occult cardiovascular disease. TNF-α and hs-cTnI correlations can reveal the interplay between disease activity and CVD. Thus, inflammation must be the primary target of various therapeutic approaches.

RA, Subclinical atherosclerosis, TNF-α, hs-cTnI, and cIMT.

Date received:
25 February 2023; accepted: 2 May 2023



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