Background Rheumatoid Heart Disease (RHD) (pericarditis, myocarditis, endocarditis) has been reported in 30–40% of RA patients in several echocardiographic studies conducted before the era of aggressive, early therapy with disease-modifying drugs (DMARDs).
Objectives We assessed whether the recent therapeutic trend of early DMARD therapy has had an impact on the prevalence of cardiac complications of RA, compared with historical controls.
Methods 52 RA out-patients (19 males, 33 females) with a mean disease duration of 11.7 yrs who had received DMARD therapy within 12 months of symptom onset (6 months since diagnosis) were assessed echocardiographically. Pericardial disease was defined as pericardial thickening (>5 mm) or effusion. Endocardial disease was defined as either mitral or aortic valve thickening or calcification.
Results Endocardial disease was seen in 12 (23.1%), pericardial disease in 11 (21.2%), left ventricular hypertrophy (LVH) in 24 (46%). Left ventricular systolic function was abnormal in 3 patients (6%) due to regional wall motion abnormalities due to previous myocardial infarction. Assessment of myocardial disease was confounded by the high prevalence of LVH. There was no significant difference between males and females. Historical controls are shown in the Table 1.
Conclusion The prevalence of pericardial and endocardial disease appears lower than that of historical controls. As with other extra-articular disease manifestations, earlier use of DMARDs may have had an advantageous impact on the development of cardiac complications of RA.