Background In RA, congestive heart failure (CHF) is an important contributor to the excess mortality. Some traditional CHF risk factors are overrepresented in RA, but they do not completely explain the risk (1). Inflammatory cytokines are suggested to contribute to development of myocardial dysfunction (1).
RA patients have had unexplained diffuse myocardial abnormality at autopsy more frequently than controls (2). At autopsy, citrullination has been been higher in the myocardium of RA compared to other diseases, suggesting a link between autoimmunity and the increased prevalence of myocardial dysfunction in RA (3).
To our knowledge, only few cardiac magnetic resonance (CMR) studies in RA patients have been published. One such study showed high prevalence of late enhancement (LGE) of the myocardium, associated with high mean disease activity score (DAS)28 (4).
Objectives We aimed to assess myocardial abnormalities in patients with active RA without cardiac symptoms by contrast enhanced CMR.
Methods Fifty-four RA patients and 12 patients with fibromyalgia (FM) underwent CMR. RA group comprised 29 patients with newly diagnosed RA starting treatment with disease modifying anti-rheumatic drugs (DMARDs) and 25 patients with chronic active RA starting biological therapy.
Contrast enhanced CMR was performed to analyze LGE of the myocardium. The location, pattern and extent of LGE were analyzed using American Heart Association (AHA) 17-segment model.
Results Mean age (SD) was 50 (12) years in RA patients and 54 (12) in FM patients. Myocardial LGE was detected in 34 RA patients (63%) and in one FM patients (p<0.001). One RA patient with newly diagnosed RA had subendocardial and circular LGE typical for cardiac amyloidosis. One patient exhibited lateral transmural LGE indicating infarct scar. Otherwise pattern on LGE was non-specific. LGE presented midmyocardial and subepicardial pattern in most cases and was predominantly located in the basal and inferior or inferolateral regions of left ventricle. In RA patients, myocardial LGE correlated with DAS28, CRP (p=0.049).
Conclusions Myocardial LGE evaluated with CMR is a common finding in patients with active RA without cardiac symptoms. Myocardial LGE shows correlation to disease activity in RA.
Giles JT et al. Myocardial dysfunction in rheumatoid arthritis: Epidemiology and pathogenesis. Arthritis Res Ther. 2005.
Koivuniemi R et al. Cardiovascular diseases in patients with rheumatoid arthritis. Scand J Rheumatol. 2013.
Giles JT et al. Myocardial citrullination in rheumatoid arthritis: A correlative histopathologic study. Arthritis Res Ther. 2012.
Kobayashi Y et al. Assessment of myocardial abnormalities in rheumatoid arthritis using a comprehensive cardiac magnetic resonance approach: A pilot study. Arthritis Res Ther. 2010.
Acknowledgements This study was supported by grants from Helsinki University Central Hospital Research Funds and the Finnish Medical Foundation.
Disclosure of Interest None declared
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