Abstract
Objective. The aim of the study was to describe echocardiographic abnormalities in patients with rheumatoid arthritis, concurrent systemic comorbidities, rheumatologic clinical activity, serologic markers of rheumatoid arthritis, and inflammatory activity. Methods. In an observational, cross-sectional study, rheumatoid arthritis outpatients were included (n = 105). Conventional transthoracic echocardiographic variables were compared between patients with arthritis and non-RA controls (n = 41). For rheumatoid arthritis patients, articular activity and rheumatologic and inflammatory markers were obtained. Results. Ventricular dysfunction was found in 54.3% of the population: systolic (18.1%), diastolic (32.4%), and/or right (24.8%), with lower ejection fraction (P < 0.0001). Pulmonary hypertension was found in 46.9%. Other echocardiographic findings included increased left atrial diameter (P = 0.01), aortic diameter (P = 0.01), ventricular septum (P = 0.01), left ventricular posterior wall (P = 0.013), and right ventricular (P = 0.01) and atrial diameters compared to control subjects. Rheumatoid factor and anti-CCP antibodies levels were significantly elevated in cases with ventricular dysfunction. Angina and myocardial infarction, diabetes, and dyslipidemia were the main risk factors for ventricular dysfunction. Conclusions. Ventricular dysfunction is common in rheumatoid arthritis and associated with longer disease duration and increased serologic markers of rheumatoid arthritis. Screening for cardiac abnormalities should be considered in this kind of patients.
Highlights
Rheumatoid arthritis (RA) is a chronic inflammatory disease [1,2,3,4], and even though its major characteristic is polyarticular affection it is associated with such extra-articular features as vasculitis, keratoconjunctivitis sicca, bronchiolitis obliterans, organizing pneumonia, portal fibrosis, secondary amyloid, and cryoglobulinemia [5]
Major variables associated with structural heart disease were increased such as age, cardiovascular disease, and diabetes mellitus as clinical entities
Among the laboratory parameters we found that rheumatoid factor and anti-CCP antibodies correlated with echocardiographic findings, as Vizzardi and Cavazzana described [16]
Summary
Rheumatoid arthritis (RA) is a chronic inflammatory disease [1,2,3,4], and even though its major characteristic is polyarticular affection it is associated with such extra-articular features as vasculitis, keratoconjunctivitis sicca, bronchiolitis obliterans, organizing pneumonia, portal fibrosis, secondary amyloid, and cryoglobulinemia [5] It has been associated with increased cardiovascular risk due to conduction and valve alterations, heart failure, and premature atherosclerosis [6,7,8]. The proposed mechanisms for this are a major systemic inflammatory state involving T cell lymphocytes, tumor necrosis factor alpha (TNF alpha), high density lipoprotein dysfunction, and treatment related hyperhomocysteinemia All of these factors lead to thickening of arterial intima, myocardial dysfunction, and in some cases myocardial infarction and are responsible for up to 50% of deaths in this population [9].
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