FRI0459
IMPACT OF ERGOMETRIC TEST IN PATIENTS WITH RHEUMATOID ARTHRITIS, ANKYLOSING SPONDYLITIS AND SYSTEMIC LUPUS ERYTHEMATOSUS, WITHOUT CARDIOVASCULAR SYMPTOMS, BEFORE STARTING A SUPERVISED PHYSICAL ACTIVITY PROGRAM
F. Jennings 1,*E. T. Reis Neto 1U. S. Siqueira 1V. L. Szejnfeld 1J. Natour 1E. I. Sato 1M. M. Pinheiro 1 and Spondyloarthritis, Rheumatoid arthritis and Systemic lupus erythematosus
1Rheumatology, Universidade Federal De São Paulo (Unifesp/ Epm), São Paulo, Brazil
Background: Cardiovascular (CV) diseases are the most relevant causes of mortality in patients with autoimmune rheumatic diseases (AIRD), including rheumatoid arthritis (RA), ankylosing spondylitis (AS) and systemic lupus erythematosus (SLE). Supervised physical exercise (SPE) is an important non-pharmacological strategy for clinical management of these patients, particularly on aspects related to metabolic syndrome and other concomitant diseases.
Objectives: To evaluate the impact of a simple ergometric test (ET) in patients with AIRD, without cardiovascular symptoms, before starting a SPE.
Methods: A total of 264 ET from sedentary 133 RA, 84 AS and 47 SLE patients were analyzed. The patients underwent ET before starting a SPE program in order to be included in 3 randomized clinical trials. Patients with CV symptoms, previous CV events, uncontrolled hypertension, severe disease activity or taking high doses of glucocorticosteroids and older than 60 years were excluded. All outcomes occurring after cardiac evaluation were examined to evaluate the impact of each one on the final clinical decision.
Results: From 264 baseline ET, 34 (12.9%) were considered positive. These patients were not included in the controlled and randomized SPE and a cardiologic evaluation was recommended. The main peculiarities of these patients as well as the outcomes can be seen in Table 1. After cardiologic evaluation, the most of them were considered clinically relevant, since there were changes in diagnosis and therapeutic management, including invasive procedures (cardiac catheterization) and specific medications. If the ET had not been performed, these patients have been missed and would be at CV risk.
Table 1. Main clinical peculiarities and outcomes of the patients with autoimmune rheumatic diseases after ergometric test.
|
RA patients (N=133) |
AS patients (N=84) |
SLE patients (N=47) |
|
Age (years) |
54.2±4.1 (18-60) |
41.8±9.7 (18-60) |
32.9±7.7 (18-45) |
|
Female gender (%) |
100 |
22 |
100 |
|
Time of disease (years) |
8.6±3.5 |
14.6±7.9 |
8.2±6.5 |
|
Positive ET (N; %) |
24; 68.6% |
6; 17.6% |
4; 11.4% |
|
Outcome (%) Hypertension IHD VA PH Fatigue/ exhaustion |
11 (45.8%) 3 (12.5%) 6 (25%) 0 4 (16.7%) |
1 (16.7%) 4 (66.6%) 1 (16.7%) 0 0 |
2 (50%) 0 1 (25%) 1 (25%) 0 |
IHD: ischemic heart disease; VA: ventricular arrhythmia; PH: pulmonary hypertension
Conclusions: Positive ET is frequent in asymptomatic patients with AIRD, particularly in RA patients. In addition, these CV abnormalities had serious clinical implications, such as systemic and pulmonary hypertension, arrhythmia and ischemic heart disease. Our data suggest that asymptomatic and sedentary patients with RA, AS and SLE should be evaluated for CV diseases before starting moderate to vigorous exercise programs.
References: 1- Garber CE, Blissmer B, Deschenes MR et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011; 43 (7): 1334-59.
2- Kamioka H, Tsutani K, Okuizumi H et al. Effectiveness of aquatic exercise and balneotherapy: a summary of systematic reviews based on randomized controlled trials of water immersion therapies. J Epidemiol. 2010; 20 (1): 2-12.
Disclosure of Interest: None Declared