Background Rheumatologists need to develop primary and secondary prevention strategies for cardiovascular disease (CVD) in rheumatoid arthritis (RA) patients. We reported tofacitinib (Tofa) improved left ventricular mass index (LVMI) in patients with rheumatoid arthritis1). We have experienced RA patient with chronic heart failure (CHF). We couldn’t use some TNF blockers in RA patients with CHF2). There is no evidence that Tofa effects on left ventricular (LV) morphology and function in RA patients with CHF.
Objectives To study the effect of Tofa on LV morphology and function in conventional synthetic (cs) DMARDs resistant active RA patients with CHF, in a cohort study design.
Methods RA patients with CHF were eligible if they had active disease despite treatment with cs DMARDs. Consecutive 24 patients with moderate to severe active RA patients (DAS28 >3.2) despite cs DMARDs were received Tofa plus cs DMARDs. LV morphology and function was assessed with cardio-MRI at baseline and 24 weeks follow-up. Cardiovascular risk factors and clinical data were collected at regular visits.
Results 21 patients completed 24 weeks. New York heart association functional classification (NYHA) class 1 is 12 cases, class 2 is 7 cases, and class 3 is 2 cases respectively. Left ventricular mass index (LVMI) was attenuated significantly by Tofa (week 0 week24, −9.02±5.8 g/m2; p=0.02). Cardiac output (CO) was attenuated significantly by Tofa (week 0 week24,−0.42±1.2 l/min). DAS28 and CRP improved significantly by Tofa (week 0 week24; DAS28: −2.16±0.95; CRP: 15.1±5.7 mg/L) (p<0.05). Surprisingly, the change of disease activity (DAS 28 and CRP) is no correlation with the change of LVMI or CO in this study. Observationally, 2 cases significantly improved right ventricular mass as well as left ventricular mass (10% improved right ventricular mass index from baseline).
Conclusions Tofa improved LVMI and CO in active RA despite cs DMARDs with CHF. Tofa improves LVMI and CO independently of its effects on disease activity. Tofa might be improved right ventricular mass. JAK-STAT pathway might be an important role of LV hypertrophy. Tofa, JAK-STAT pathway blocking, may prevent cardiovascular morbidity and mortality in RA with CHF.
References  Kume K, et al. Tofacitinib improves left ventricular mass and cardiac output in patients with rheumatoid arthritis. Presentation at Annual Meeting of EULAR 2017.
 Hochenberg MC, et al. The benefit/risk profile of TNF-blocking agents: findings of a consensus panel. Semin Arthritis Rheum2005Jun;34(6):819–36.
Disclosure of Interest None declared
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