Microalbuminuria in Rheumatoid Arthritis Patients: Clinical and Biochemical Correlates

Abstract

Background: Microalbuminuria is associated with increased risk for renal and cardiovascular mortality and morbidity in diabetes mellitus, hypertension and patients with acute myocardial infarction but the significance of microalbuminuria in rheumatoid arthritis and its correlation with clinical and biochemical parameters of disease activity is not well studied. The present study is therefore aimed to determine the presence of microalbuminuria in rheumatoid arthritis patients and to correlate it with indicators of disease activity. Materials and methods: Hundred confirmed cases of rheumatoid arthritis (2010 ACREULAR criteria) were taken. Those suffering from hypertension, diabetes mellitus and renal disease were excluded. Microalbumin was assessed by immunoturbidimetric method on Delta nephelometer. Disease activity was assessed by CRP and ESR. Results: Out of 100 RA, 30 (30%) were males and 70 (70%) females with a mean age of patients 43(17 ± 11.16 years). 28(28%) cases had microalbuminuria. Duration of morning stiffness was significantly longer in patients with microalbuminuria. Out of 28 patients positive for microalbuminuria, 12 patients had morning stiffness lasting >60 min. Mean no. of joints involved was 18.96 ± 6.01 in microalbuminuria positive group (P<0.001).14 of the 28 patients with microalbuminuria had evidence of erosions on xray (P value of <0.001). Mean ESR in microalbuminuria positive patients was 87.93 ± 26.02 mm in 1st hour (P value of <0.001). Mean CRP in microalbuminuria positive patients was 48.78 ± 16.06 mg/l (P value of <0.001). Mean value of RA in microalbuminuria positive patients was 211.89 ± 97.39 IU/dl (P value of <0.001).An independent association was found between levels of RA Factor (β=0.540, P <0.001) and level of microalbuminuria. Conclusion: RA patients having microalbuminuria have significant clinical and biochemical correlation with severe disease activity.Immunological methods for detecting microalbuminuria should routinely be used in all rheumatoid arthritis patients to detect renal involvement in an incipient stage so as to minimize disease morbidity.