Romatoid Artrit Hastalarında Epikardiyel Yağ Dokusu: Basit Bir Yağ Dokusundan Daha Fazlası mı?

Abstract

Romatoid artrit (RA), kronik eklem iltihabı ile karakterize, ilerleyici sakatlığa yol açan ve hastaların yaşam kalitesini önemli ölçüde etkileyen bir otoimmün hastalıktır. RA patogenezinin altında yatan kesin mekanizmalar henüz netlik kazanmamıştır. Metabolik olarak aktif bir yağ dokusu olan epikardiyal yağ dokusu (EYD), sistemik inflamasyon ve kardiyovasküler riskle ilişkilendirilmiştir. EYD 'nin RA patogenezindeki rolü yeni araştırma alanlarından biri olmuştur. Bu çalışma, RA hastalarında EYD ile klinik ve laboratuvar özellikleri arasındaki ilişkiyi değerlendirmeyi amaçlamaktadır. Tek merkezli kesitsel çalışmaya Romatoloji kliniğinde takipli toplam 342 birey dahil edildi. Katılımcılar iki gruba ayrıldı: 200 RA hastası ve 142 yaş eşleştirilmiş sağlıklı kontrol (SK). Laboratuvar ve radyoloji sonuçları elektronik veritabanından elde edildi. Veriler analiz edildi ve gruplar arasında karşılaştırıldı. EYD bilgisayarlı tomografi (BT) kullanılarak ölçüldü ve klinik özellikler ve inflamasyon belirteçleriyle korelasyonları değerlendirildi. EYD'nin RA'da SK'ye göre anlamlı olarak yüksek olduğu bulundu. EYD ile aktivite skoru (DAS28) (p<0,001) arasında güçlü, yaş, lökosit, lenfosit, RDW ve CRP (p<0,05) arasında zayıf pozitif korelasyon vardı. Tedavi açısından karşılaştırıldığında anlamlı bir fark yoktu. ROC analizi, EYD'nin 123,68 kesme değerinde %69,0 duyarlılık ve %51,4 özgüllükle 0,604'lük bir AUC (95% CI: 0,542-0,666, p<0,001) ile orta düzeyde bir ayırt edici güce sahip olduğunu gösterdi. EYD, RA hastalarında aktif inflamasyon göstergesi olabilir.

Keywords

• Epikardiyal yağ dokusu
• İnflamasyon
• Romatoid Artrit

Supporting Institution

Herhangi bir destekleyen kurum yok

Ethical Statement

Çalışma protokolü kurumsal etik kurul tarafından onaylandı (Onay Numarası: 2021/297) ve tüm işlemler Helsinki Deklarasyonu ilkelerine uygun olarak gerçekleştirildi.

Thanks

Selçuk Üniversitesi Romatoloji ve Radyoloji çalışma ekibine teşekkür etmek istiyorum.

Epicardial Adipose Tissue in Rheumatoid Arthritis Patients: More Than A Simple Fat Deposit?

Abstract

Rheumatoid arthritis (RA) is a multifaceted autoimmune disorder characterized by chronic joint inflammation, leading to progressive disability and significantly impacting patients’ quality of life. The exact mechanisms underlying RA pathogenesis remain unclear. Epicardial adipose tissue (EAT), a metabolically active form of adipose tissue, has been linked to systemic inflammation and increased cardiovascular risk. One emerging area of research in RA is the role of EAT in the pathogenesis of the disease. This study aims to investigate the relationship between EAT and clinical and laboratory features in patients with RA. A total of 342 patients were recruited from the rheumatology department of a single center cross-sectional study. The participants were divided into two groups: 200 patients with RA and 142 age-matched healthy controls (HC). Laboratory and radiology results were obtained from the electronic registration database. Data were analyzed and compared between groups. EAT was measured using computed tomography (CT), and its correlations with clinical features and inflammatory markers were evaluated. EAT was found to be significantly higher in the RA than HC. There was a strong positive correlation between EFV and activity score (DAS28) (p<0.001) and weak positive correlation between EFV and age, leukocyte, lymphocyte, RDW and CRP (p<0.05). The EAT did not differ significantly in terms of treatment. ROC analysis showed a moderate discriminatory power of EAT with an AUC of 0.604 (95% CI: 0.542-0.666, p<0.001) with a sensitivity of 69.0% and a specificity of 51.4% at a cut-off value of 123.68. EAT may be an indicator of active inflammation in RA patients.

Keywords

• Epicardial adipose tissue
• Inflammation
• Rheumatoid Arthritis

Supporting Institution

The authors declare that they have no funding

Ethical Statement

The study protocol was approved by the institutional ethics committee (Approval Number: 2021/297), and all procedures were performed in line with the principles of the Declaration of Helsinki.

Thanks

I would like the thank the Selçuk University Romatology anad radiology study team

References

1. 1. Weber B, Weisenfeld D, Massarotti E, et al. Interplay Between Systemic Inflammation, Myocardial Injury, and Coronary Microvascular Dysfunction in Rheumatoid Arthritis: Results From the LiiRA Study. J Am Heart Assoc. 2024 May 7;13(9):e030387.
2. 2. Ruscitti P, Cipriani P, Masedu F, et al. Increased cardiovascular events and subclinical atherosclerosis in rheumatoid arthritis patients: 1 year prospective single centre study. PLoS ONE. 2017;2:e0170108
3. 3. Giollo A, Dal Sacco C, Ometto F, et al. Epicardial adipose tissue in rheumatoid arthritis: An emerging marker of cardiovascular risk. Autoimmun Rev. 2021;20(6):102832.
4. 4. Tana C, Ticinesi A, Prati B, et al. Epicardial fat: the role of a new cardiovascular risk marker. Acta Biomed. 2020;91(2):173-183.
5. 5. Jolfayi AG, Beheshti AT, Hosseini SM, et al. Epicardial adipose tissue features as a biomarker and therapeutic target in coronary artery disease. Sci Rep. 2025;15(1):14786.
6. 6. Spearman JV, Renker M, Schoepf UJ, et al. Prognostic value of epicardial fat volume measurements by computed tomography: a systematic review of the literature. Eur Radiol. 2015;25(11):3372-3381.
7. 7. Han R, Hou J, Xia P, Xing Y, Liu W. Predicting abnormal epicardial adipose tissue in psoriasis patients by integrating radiomics from non-contrast chest CT with serological biomarkers. BMC Med Imaging. 2025;25(1):240
8. 8. Long BD, Stojanovska J, Brown RKJ, et al. Increased Epicardial Fat Volume Is Independently Associated with the Presence and Severity of Systemic Sclerosis. Acad Radiol. 2017 Dec;24(12):1473-1481.

9. 9. Hakbilen S, Yılmaz S, Özer H, et al. Evaluation of epicardial fat thickness, a new indicator of the cardiovascular risk factor, in patients with systemic lupus erythematosus. Rheumatol Q. 2023;1(3):104-109.
10. 10.Torres T, Bettencourt N, Mendonça D, et al. Epicardial adipose tissue and coronary artery calcification in psoriasis patients. J Eur Acad Dermatol Venereol. 2015;29:270–277.
11. 11.Lima-Martinez MM, Campo E, Salazar J, et al. Epicardial fat thickness as cardiovascular risk factor and therapeutic target inpatients with rheumatoid arthritis treated with biological and nonbiological therapies. Arthritis. 2014;2014:782850
12. 12.Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College ofRheumatology/European League Against Rheumatismcollaborative initiative. Ann Rheum Dis. 2010;69:1580–1588.
13. 13.Anderson J, Caplan L, Yazdany J, et al. Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care Res(Hoboken) 2012;64:640–647.
14. 14.Mazurek T, Zhang L, Zalewski A, et al. Human epicardial adipose tissue is a source of inflammatory mediators.Circulation. 2003;108(20):2460-2466.
15. 15.Sagris M, Antonopoulos AS, Theofilatos K, et al. Epicardialadipose tissue: not just fat! J Mol Cell Cardiol. 2021;158:17–25.
16. 16.Packer M. Epicardial Adipose Tissue May Mediate DeleteriousEffects of Obesity and Inflammation on the Myocardium. J AmColl Cardiol. 2018;71(20):2360-2372.
17. 17.Masson W, Lavalle-Cobo A, Barbagelata L, Lobo M, NogueiraJP. Relationship between epicardial adipose tissue, systemicinflammatory diseases, and subclinical atheromatosis: A systematic review. Reumatol Clin. 2023;19(7):363-373.
18. 18.Shi H, Wu H, Winkler MA, et al. Perivascular adipose tissue inautoimmune rheumatic diseases. Pharmacol Res.2022;182:106354.
19. 19.Temiz Karadag D, Sahin T, Tekeoglu S, et al. Epicardial adipose tissue thickness in systemic sclerosis patients without overt cardiac disease. Rheumatol Int. 2019;39(7):1191-1200.
20. 20.Wang X, Butcher SC, Myagmardorj R, et al. Epicardial adipose tissue in patients with systemic sclerosis. Eur Heart J Imaging Methods Pract. 2023;1(2):qyad037.
21. 21.Baysal E, Yilmaz N, Karadag O, et al. Epicardial adipose tissue thickness and systemic sclerosis. Acta Medica Maditerranea.2015;31:97–101
22. 22. Uysal F, Akbal E, Akbal A, et al. Epicardial Adipose Tissue IsIncreased in Patients With Inflammatory Bowel Disease. JUltrasound Med. 2016;35(9):1859-1864.
23. 23.Lipson A, Alexopoulos N, Hartlage GR, et al. Epicardial adipose tissue is increased in patients with systemic lupus erythematosus. Atherosclerosis. 2012;223(2):389-393.
24. 24.Okçu M, Koçak FA, Şaş S, Güçlü K. Epicardial adipose tissuethickness and growth differentiation factor 15 in axial spondyloarthritis: A cross-sectional study. Saudi Med J. 2022;43(9):1020-1026.
25. 25.Resorlu H, Akbal A, Resorlu M, et al. Epicardial adipose tissuethickness in patients with ankylosing spondylitis. Clin Rheumatol. 2015;34(2):295-299.
26. 26.Motawea KR, Kandil OA, Varney J, et al. Association offamilial Mediterranean fever and epicardial adipose tissue: A systematic review and meta-analysis. Health Sci Rep.2022;5(4):e693.
27. 27.Chen X, Xiang H, Lu J, Yang M. Epicardial Adipose Tissue and Psoriasis: A Systematic Review and Meta-Analysis. J Clin Med. 2024;13(16):4761.
28. 28. Bacaksız A, Tasal A, Sevgili E, et al. Epicardial fat thickness in patients with psoriasis vulgaris. Turk Kardiyol Dern Ars.2014;42(1):47–54
29. 29.Fatma E, Bunyamin K, Savas S, et al. Epicardial fat thicknessin patients with rheumatoid arthritis. Afr Health Sci. 2015 Jun;15(2):489-95
30. 30.Saha S, Singh R, Mir IA, et al. Epicardial Fat Thickness: A Cardiometabolic Risk Marker in Rheumatoid Arthritis. Cureus. 2022 Jan 18;14(1):e21397.
31. 31.Ekinci B, Mertoglu C, Coskun R, et al. The relationshipbetween rheumatoid arthritis and epicardial fat thickness, andserum levels of chemerin, adropin, and betatrophin. Adv ClinExp Med. 2025 May;34(5):709-715.
32. 32.Yao H, Chen J, Li X, Zhang X. Relationship between epicardial adipose tissue volume and atrial fibrillation in patients with rheumatoid arthritis. Front Cardiovasc Med. 2025 Apr9;12:1508025.
33. 33.Başpınar N, Solak O, İsmail Ş, Sezer F. Examination of the epicardial fat area in patients with rheumatoid arthritis by computed tomography of the thorax. Cumhur Medical J. 2019;41:506–515.
34. 34.Keleşoğlu Dinçer AB, Şahan HF. Increased epicardial adipose tissue thickness as a sign of subclinical atherosclerosis in patients with rheumatoid arthritis and ıts relationship with disease activity ındices. Intern Emerg Med. 2024 Jun;19(4):1015-1024.
35. 35.Ormseth MJ, Lipson A, Alexopoulos N,et al. Association of epicardial adipose tissue with cardiometabolic risk and metabolic syndrome in patients with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2013 Sep;65(9):1410-5.
36. 36.Alpaydın S, Buyukterzi Z, Akkurt HE, Yılmaz H. ImpairedLeft Ventricular Diastolic Functions and Thickened Epicardial Adipose Tissue in Rheumatoid Arthritis Patients is Correlatedwith DAS-28 Score. Acta Cardiol Sin. 2017 Mar;33(2):182-187.
37. 37.Delkash P, Bayat B, Omidi F. Epicardial fat thickness inrheumatoid arthritis: Insights from echocardiographic analysisand autoimmune correlations. Int J Rheum Dis. 2024 Aug;27(8):e15272.
38. 38.Petra CV, Albu A, Pamfil C, et al The relationship betweenepicardial adipose tissue and arterial stiffness in patients with rheumatoid arthritis. Med Ultrason. 2019 Nov 24;21(4):427-434.
39. 39. Kitterer D, Lotus J, Birkmeier S, et al. Impact of long-term steroid therapy on epicardial and pericardial fat deposition: a cardiac MRI study. Cardiovasc Diabetol. 2015;14:130–140.
40. 40.Karpouzas GA, Rezaeian P, Ormseth SR, Hollan I, Budoff MJ. Epicardial Adipose Tissue Volume As a Marker of Subclinical Coronary Atherosclerosis in Rheumatoid Arthritis. ArthritisRheumatol. 2021;73(8):1412-1420.