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Myocardial Inflammation and Disease Activity in RA

Arthritis Rheumatol; ePub 2019 Feb 28; Amigues, et al

Subclinical myocardial inflammation is frequent in patients with rheumatoid arthritis (RA), is associated with RA disease activity, and may decrease with RA therapy, according to a recent study. RA patients (n=119) without known cardiovascular disease (CVD) underwent cardiac 18‐fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET‐CT). Myocardial FDG uptake was assessed visually and measured quantitatively as the standardized uptake value (SUV). A subset of RA patients who had to escalate their disease‐modifying antirheumatic drug (DMARD) therapy (n=8) underwent a second FDG PET‐CT scan after 6 months, to assess treatment‐associated changes in myocardial FDG uptake. Researchers found:

  • Visually assessed FDG uptake was observed in 46 (39%) of the 119 RA patients, and 21 patients (18%) had abnormal quantitatively assessed myocardial FDG uptake.
  • The SUVmean was 31% higher in patients with a Clinical Disease Activity Index (CDAI) score of ≥10 (moderate‐to‐high disease activity) as compared with those with lower CDAI scores (low disease activity or remission), after adjustment for potential confounders.
  • The adjusted SUVmean was 26% lower among those treated with a non–tumor necrosis factor–targeted biologic agent compared with those treated with conventional (non-biologic) DMARDs.

Citation:

Amigues I, Tugcu A, Russo C, et al. Myocardial inflammation, measured using 18‐lluorodeoxyglucose positron emission tomography with computed tomography, is associated with disease activity in rheumatoid arthritis. [Published online ahead of print February 28, 2019]. Arthritis Rheumatol. doi:10.1002/art.40771.

Commentary:

Rheumatoid arthritis is a systemic disease; the joint disease of course predominates, but we are becoming more cognizant of extra-articular manifestations in examining the true “burden” of disease. While pulmonary and ophthalmic complications are well-described, it is only in the relatively recent past that we have learned about the negative effects of uncontrolled systemic inflammation on risk of cardiovascular disease in RA patients. Myocardial inflammation is not commonly thought of as an RA manifestation or complications. In this study, Amigues et al not only demonstrated myocardial FDG uptake in PET scans of RA patients, but a correlation of degree of uptake (SUVmean) to disease activity. A small number of patients also had PET scans post-treatment escalation showing a measurable decrease in FDG uptake that did not reach statistical significance. This study convincingly highlights the myocardium as another possible site for RA’s systemic effects, and reinforces the importance of controlling RA disease activity. —Arundathi Jayatilleke, MD