Patients with newly diagnosed rheumatoid arthritis already show increased aortic stiffness as well as lower left and right ventricular, end-systolic, and end-diastolic volumes, Dr. Maya Buch reported at the European Congress of Rheumatology.
The imaging findings lend support to a growing view that inflammation may underlie cardiovascular as well as rheumatic disease, Dr. Buch said in an interview.
“Rheumatoid arthritis is associated with increased cardiovascular disease and death. This is thought to be due to the inflammatory drive as well as traditional risk factors,” said Dr. Buch of the University of Leeds (England). “There is also a significant literature base suggesting atherosclerosis is inflammation driven, thus, shared mechanisms are likely.”
Dr. Buch and her colleagues conducted cardiac magnetic resonance imaging studies on 66 patients with early rheumatoid arthritis; all were treatment naive and had symptoms of less than 1 year in duration. They were matched for age, gender, and blood pressure with 30 healthy controls.
Patients had a mean age of about 48 years; mean systolic blood pressures were similar – 122 mm Hg for patients and 126 mm Hg for controls.
In the patients, the median erythrocyte sedimentation rate was 39.5 mm/hr; C-reactive protein was 18.9 mg/L. The mean Disease Activity Score 28 was 5.65. Most (82%) were positive for anticitrullinated protein antibodies; 73% were positive for rheumatoid factors.
Patients showed significantly reduced aortic distensibility, compared with controls. Aortic compliance and aortic strain were also significantly lower in patients, while aortic stiffness was significantly higher.
Evidence of early cardiac remodeling was present. Left ventricular and right ventricular end-systolic and end-diastolic volumes were all lower in the patients. A trend for lower left ventricular mass index seemed to be associated with seropositivity, Dr. Buch noted. Four patients showed evidence of overt inflammation or fibrosis with focal nonischemic patterns of late gadolinium enhancement.
These changes suggest an early cardiomyopathy, Dr. Buch said, and could imply a higher risk for cardiovascular morbidity and mortality at time of diagnosis. She added that the next steps in learning about this association will be to clarify its natural history, clinical implications, and the potential to modify outcomes with effective therapy. Although these new data are striking, they aren’t enough to recommend that newly diagnosed patients get routine cardiac imaging, Dr. Buch said.
“The study clearly implies that subclinical cardiovascular pathology exists at the early stage. Screening wouldn’t be appropriate at this stage – the clinical outcome and relevance of subclinical disease is not yet clear. However further evaluation will clarify whether additional benefits of RA disease control – for example, improving the cardiovascular risk and abnormalities seen here – are possible. This could influence future management approach.”