Subclinical Heart Inflammation Seen in RA

Simplified by DC from Nancy Walsh, Senior Staff Writer, MedPage Today November 12, 2018

Unnoticed heart inflammation is common among patients with rheumatoid arthritis (RA) and is associated with articular disease activity, researchers reported. Among a group of RA patients without recognised cardiovascular disease who underwent cardiac testing (FDG PET-CT), 47% had visually positive readings according to the researcher Joan M. Bathon, MD, of Columbia University in New York City, and colleagues. 

Heart failure is an important factor contributing to cardiovascular disease in RA, and tends to have fewer symptoms but higher mortality than in the wider population. Levels of circulating cytokines such as tumour necrosis factor (TNF) and interleukin-6, which are predictive of heart failure in the general population, are considerably higher in RA, but few studies have addressed inflammation caused by RA.

Autopsy studies from the mid-20th century identified heart issues in up to 20% of RA patients.  Today, however, heart and associated inflammation also can be detected with FDG PET-CT. 

To explore the possibility that inflammation would be detectable in RA patients without apparent heart failure, and to see if this linked with disease activity, the researchers analysed 119 patients with RA from the RHYTHM study who had FDG PET-CT scans.  Participants' mean age was 54, median disease duration was 6.7 years, and most were women. Three-quarters were seropositive, and the majority had low to moderate disease activity. Most were being treated with disease-modifying antirheumatic drugs, usually methotrexate, and more than one-third were on biologics. Prednisone was being used by one-third and more than 40% were taking nonsteroidal anti-inflammatory drugs. Troponin-I levels were undetectable in all, indicating absent heart damage.

On analysis, factors that were associated with a likelihood of heart disease were race and a higher body mass index.