Relationship between disease activity and hearing ...

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novial joints, the incudostapedial and incudomalleolar joints of the middle ear may be affected, causing conductive HI. However, extra-articular involvement ...
Clin Rheumatol (2016) 35:309-314 DOI 10.1007/s10067-015-3129-1

ORIGINAL ARTICLE

Relationship between disease activity and hearing impairment in patients with rheumatoid arthritis compared with controls Adem Yildirim 1 & Gulseren Surucu 1 & Sedat Dogan 2 & Mehmet Karabiber 1

Received: 30 September 2015 / Revised: 29 October 2015 / Accepted: 21 November 2015 # International League of Associations for Rheumatology (ILAR) 2015

Abstract The characteristics of hearing impairment (HI) in rheumatoid arthritis (RA) are still poorly understood, and their association with disease activity is based on conflicting information. This study compared HI between RA patients and controls and between active and remission RA groups using multi-frequency audiometry. This study enrolled 88 RA patients and 50 controls. The pure-tone hearing thresholds at 500 to 4000 Hz for air (AC) and bone (BC) conduction were compared between RA and controls as well as between active and remission RA patients using DAS28-CRP scores. The puretone hearing thresholds for AC and BC were significantly higher at high frequencies (2000 and 4000 Hz) in the RA group for both ears compared with controls. In addition, the BC threshold at 1000 Hz for the right ear was higher in the RA group than controls. When active and remission RA patients were compared, the thresholds were higher only at 4000 Hz for both ears for AC and BC in patients with active RA. The air-bone gap differed significantly at 2000 and 4000 Hz in both ears. This study demonstrated that patients with RA have a heightened risk of HI, and disease activity increases this risk, particularly at high frequencies. Clinicians who manage RA should be aware of HI and consider performing audiological evaluations in RA patients with active disease in particular.

The study was performed at the Education and Research Hospital of Adiyaman University, Adiyaman, Turkey * Adem Yildirim [email protected] 1

Department of Physical Medicine and Rehabilitation, Medical Faculty of Adiyaman University, Adiyaman, Turkey

2

Department of Otorhinolaryngology, Medical Faculty of Adiyaman University, Adiyaman, Turkey

Keywords Disease activity . Hearing impairment . Rheumatoid arthritis

Introduction Rheumatoid arthritis (RA) is a chronic inflammatory disorder that affects approximately 1 % of the population and is characterised by inflammation of the synovial membranes of diarthrodial joints, which leads to progressive destruction of articular and periarticular tissues [1]. Extra-articular involvement is a feature of RA and multiple organs and systems may be affected. Although it is generally accepted that the auditory system is negatively affected in patients with RA, the characteristics of the hearing impairment (HI) are still poorly understood. The HI in RA patients can be conductive, sensorineural, or of mixed type. Many studies comparing patients with and without RA found sensorineural HI in 25–72 % of patients, conductive HI in 4–23 %, and some mixed-type HI [2–9]. Along with the primary erosive arthritis of the peripheral synovial joints, the incudostapedial and incudomalleolar joints of the middle ear may be affected, causing conductive HI. However, extra-articular involvement (vasculitis and neuritis) may also affect the cochlea and the cochlear nerve and lead to sensorineural HI. The finding that sensorineural HI is more frequent in RA patients and the fact that several parameters (such as age, disease duration, drugs used, and disease activity) may affect HI have compelled researchers to investigate more complex mechanisms. Only a few studies have investigated the relationship between clinical or serological disease activity and HI, with various results [2, 5, 6, 9–12]. Disease activity was assessed using various parameters, such as the erythrocyte sedimentation rate (ESR) [2, 6, 9–11], C-reactive protein (CRP) [2, 11], rheumatoid nodules [6], rheumatoid factor (RF) [5, 10], bone erosions

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[5], the disease activity score-28 joints (DAS28) [11], and anti-nuclear antibodies [5]. Some studies, but not others, found a significant relationship between disease activity and HI. This study compared the HI in RA vs. controls as well as in active vs. remission RA groups, which were determined using the DAS28-CRP scores with multi-frequency audiometry. To our knowledge, this is the first study investigating the effect of disease activity using DAS28-CRP scores of HI in patients with RA, in addition to comparing RA patients vs. controls with a relatively large RA cohort.

Materials and methods Setting and study population This prospective controlled study was approved by the Ethics Committee of Adiyaman University, Turkey. The study included 88 RA patients with a minimum of 12 months of disease duration diagnosed according to the American College of Rheumatology (ACR-1987) criteria and 50 rheumaticdisease-free controls with normal audiometry tests. All participants gave informed consent before joining the study. Patients with rheumatic disease other than RA, a perforated or scarred tympanic membrane, otorrhoea, congenital HI, congenital head and neck anomalies, middle ear effusion, occupational noise exposure, head trauma, chronic neurological disease, Meniere’s syndrome, or ototoxic drug use (i.e., high-dose salicylate, streptomycin, etc.) were excluded from the study.

Clin Rheumatol (2016) 35:309-314

in all RA patients according to the DAS28-CRP was calculated and used as the basis for dividing patients into two groups: the RARemission group, DAS28-CRP