Evaluation Of Uric Acid And Lipid Profile Level In Postmenopausal Women Having Arthritis In Federal University Teaching Hospital, Owerri

ABSTRACT

Postmenopausal women are at a higher risk of developing metabolic and inflammatory disorders, including arthritis, due to hormonal changes that affect uric acid and lipid metabolism. This study aims to evaluate the levels of uric acid and lipid profile, including cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL), in postmenopausal women with arthritis compared to apparently healthy controls at Federal University Teaching Hospital, Owerri. A total of forty five (45) subjects were studied. The study population consists of 15 postmenopausal women without arthritis, 15 postmenopausal women with arthritis and 15 premenopausal women (Control). Blood samples were collected, and serum uric acid and lipid profiles (cholesterol, triglycerides, HDL, and LDL) were measured using standard biochemical methods. Statistical analysis was conducted to compare the groups and assess the correlation between uric acid and lipid parameters in the arthritis group. The mean uric acid level in postmenopausal women with arthritis (6.93 ± 0.28 mg/dL) was significantly higher than in the control group (4.49 ± 0.14 mg/dL) (P < 0.05). Total triglycerides (184.93 ± 7.82 mg/dL) and cholesterol (244.8 ± 5.77 mg/dL) were also significantly elevated compared to the control (130.67 ± 2.38 mg/dL and 189.87 ± 2.95 mg/dL, respectively) (P < 0.05). HDL levels were significantly lower in the test group (44.93 ± 2.31 mg/dL) compared to controls (60.8 ± 1.26 mg/dL) (P < 0.05), while LDL was higher (163.6 ± 3.78 mg/dL vs. 119.87 ± 1.64 mg/dL) (P < 0.05). Postmenopausal women without arthritis showed similar trends with significantly higher uric acid, triglycerides, cholesterol, and LDL, and lower HDL compared to controls (P < 0.05). This study will provide insights into the relationship between uric acid, lipid profile, and arthritis in postmenopausal women, which may help in understanding the metabolic disturbances associated with menopause and arthritis.

CHAPTER ONE

INTRODUCTION

1.1   Background of the Study

Menopause denotes a condition of permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity and cessation of menstruation (Lobo et al., 2021). There are various hormonal changes which take place in women after menopause and lead to alterations in lipid metabolism and increases the risk of coronary artery disease in women. Up to the age of 50 yrs incidence of CAD is lower in women but after that the incidence becomes similar in both men and women (Cı´fkova et al., 2022). As Life expectancy is increasing in terms of age in women and menopause remains relatively unchanged, so women are now spending more of their life in the post-menopause period.

Post-menopausal women have a high risk to develop cardiovascular disease and arthritis (Lobo et al., 2021). Dyslipidemia, inflammation, and oxidative stress (OS) have been implicated in the development of CVD and arthritis in post-menopausal women (Lizcano and Guzman, 2021).

Rheumatoid Arthritis (RA) is a chronic systemic inflammatory disease where assessment of disease activity is essential for management of patient (Aletaha et al., 2022).

It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body. The disease may also affect other parts of the body, including skin, eyes, lungs, heart, nerves and blood (Aletaha et al., 2022). This may result in a low red blood cell count, inflammation around the lungs, and inflammation around the heart. Fever and low energy may also be present. Often, symptoms come on gradually over weeks to months (Majhi and Srivastava, 2022).

While the cause of rheumatoid arthritis is not clear, it is believed to involve a combination of genetic and environmental factors (Aletaha et al., 2022). The underlying mechanism involves the body’s immune system attacking the joints. This results in inflammation and thickening of the joint capsule. It also affects the underlying bone and cartilage. The diagnosis is made mostly on the basis of a person’s signs and symptoms (Majhi and Srivastava, 2022). X-rays and laboratory testing may support a diagnosis or exclude other diseases with similar symptoms. Other diseases that may present similarly include systemic lupus erythematosus, psoriatic arthritis, and fibromyalgia among others (Majhi and Srivastava, 2022).

Uric acid (UA) is the final metabolite of purine metabolism in humans. It is produced by xanthine oxidase and can crystallize into monosodium urate, which is a causative factor of gout and urinary stones. UA can act as a proinflammatory and pro-oxidative agent when its levels exceed the physiological range, and hyperuricemia is traditionally considered a risk factor for conditions like metabolic syndrome, chronic kidney diseases, and cardiovascular diseases (Parks et al., 2018). Conversely, serum UA within the physiological range exerts anti-inflammatory and anti-oxidative effects, which play a defensive role in oxidative stress-induced diseases and in aging.

Lipids are the major macromolecules essential for various biological functions, including energy production, signaling, and cell growth and division. Defects in lipid metabolism are associated with several diseases, among which atherosclerosis, hypertension, obesity, diabetes, and cancer are the most important (Duncan et al., 2021).

The term dyslipidemia is used to denote the presence of any of the following abnormalities, occurring alone or in combination-increased concentration of TC or LDL-C or serum TG or a decreased concentration of HDL-C (Akahoshi et al., 2020).

Increase in the incidence of cardiovascular disease is related to many risk factors such as Hypertension, Diabetes mellitus, Dyslipedemia, increase in body weight, ageing process, physical inactivity, mental stress, smoking and alcohol intake. In the United States, more than 500,000 women die of cardiovascular disease and about half are due to coronary artery disease (CAD). As the incidence of CAD is higher in men but it increases significantly in women after menopause (Derby et al., 2019). The changes in the hormonal status after menopause such as low estrogen, increased luteinizing hormone and follicular stimulating hormone exert significant effect on plasma lipids and lipoproteins metabolism in post-menopausal women.

Several epidemiologic studies have shown that postmenopausal women tend to have significantly different lipid profiles as compared with premenopausal women. A number of lipoprotein changes occur that characterize the menopausal transition (Akahoshi, 2020).  Post-menopausal women have increased levels of LDL-C, total cholesterol, and apolipoprotein B as compared with premenopausal women. In the Framingham Study, investigators documented an increase in cholesterol levels that coincided with menopause, suggesting a causal role of menopause in altering lipid levels (Hjortland, 2020). In addition to a higher LDL-C, investigators have noted menopause to be associated with a transition in LDL particles to more atherogenic smaller and more dense particles. Total HDL cholesterol and HDL2 also decrease in postmenopausal women (Matthews, 2019). Elevated Lp(a) levels has been associated with an increased CHD risk and has been reported to increase in women following total hysterectomy and oophorectomy..

1.2   Justification

Cardiovascular disease is the main cause of mortality in postmenopausal women and the factors that increase cardiovascular risk are well known but there is no evidence of relationship between menopause and cardiometabolic changes (Derby et al., 2019). Some results show metabolic variations during menopause in Nigerian women but WHO data are insufficient to determine an association between metabolic changes and menopausal transition. Numerous studies conducted by some researchers have revealed that various forms of dyslipidemia exists during the postmenopausal years of women, but there is authenticity of the report has not been confirmed. Rheumatoid arthritis is widely prevalent throughout the world. It occurs in approximately 1% of adult population worldwide (Karie et al., 2018).  In all reports has it that rheumatoid arthritis is more prevalent in postmenopausal women than women in their reproductive years and usually develops in 4th and 5th decades of life with 80% of total cases occurring between ages of 35 and 50 (Lindqvist et al., 2022).

Inflammation has been proposed as a fundamental promoter of cardiometabolic disease, interacting with many pathophysiologic pathways leading to vascular damage due to increase lipid peroxidation (Carr et al., 2018). Postmenopausal women who are already deprived of the protective effects of endogenous estrogen and leading an unhealthy lifestyle have an increased tendency to weight gain due to increase level of total cholestereol and triglyceride. In spite of impressive researches, the reasons for alteration in lipid profile and uric acid level in menopausal women with arthritis still remains unclear, hence this study is aimed at evaluating the level of lipid profile and uric acid in menopausal women with arthritis.

1.3    Significance of the Study

Rheumatoid arthritis is a systemic disease with a variety of extra articular involvements like blood vessels (vasculitis), lungs (interstitial fibrosis, pulmonary nodules and pneumonitis), heart (pericarditis) and haematological (anaemia, splenomegaly) etc (Majhi and Srivastava, 2022). There have been reports by several studies that the onset of menopause is primarily the cause of arthritis in aged women (Karie et al., 2018). This study is designed to evaluate lipid profile and uric acid level in menopausal women with arthritis, the result will aid the clinician in the diagnosis, treatment and management of the disease in postmenopausal women.

1.4   Aim and Objectives

Aim

To evaluate the level of uric acid and lipid profile in postmenopausal women having arthritis in Federal University Teaching Hospital, Owerri.

Specific Objectives

1. To evaluate the level of uric acid in postmenopausal women having arthritis and to compare it with the control.
2. To evaluate the level of triglyceride, total cholesterol, HDL and LDL in postmenopausal women having arthritis and to compare it with control.
3. To correlate the level of uric acid with triglyceride, total cholesterol, HDL and LDL in postmenopausal women having arthritis and to compare with the control.

1.5      Research Question

1. What is the level of uric acid in postmenopausal women with arthritis compared to the control group of postmenopausal women without arthritis?

2. What are the levels of triglycerides, total cholesterol, HDL, and LDL in postmenopausal women with arthritis compared to the control group?
3. What is the correlation between uric acid levels and lipid profiles (triglycerides, total cholesterol, HDL, and LDL) in postmenopausal women with arthritis?

1.6   Hypothesis

– Hypothesis 1 (Null): There is no significant difference in the level of uric acid between postmenopausal women with arthritis and the control group.

– Hypothesis 1 (Alternative): There is a significant difference in the level of uric acid between postmenopausal women with arthritis and the control group.

– Hypothesis 2 (Null): There are no significant differences in the levels of triglycerides, total cholesterol, HDL, and LDL between postmenopausal women with arthritis and the control group.

– Hypothesis 2 (Alternative): There are significant differences in the levels of triglycerides, total cholesterol, HDL, and LDL between postmenopausal women with arthritis and the control group.

– Hypothesis 3 (Null): There is no significant correlation between the level of uric acid and the levels of triglycerides, total cholesterol, HDL, and LDL in postmenopausal women with arthritis.

– Hypothesis 3 (Alternative): There is a significant correlation between the level of uric acid and the levels of triglycerides, total cholesterol, HDL, and LDL in postmenopausal women with arthritis.

Pages:  85

Category: Project

Format:  Word & PDF               

Chapters: 1-5                                          

Source: Imsuinfo                            

Material contains Table of Content, Abstract and References.