Cardiac involvement in rheumatoid arthritis: evidence of silent heart disease

Background: Rlieumatoid arthritis (RA) is a systemic diseaseinvolving many organ systems and is frequently accompanied bycardiac alterations. However, there is considerable disagreementconcerning the cardiac abnormalities found in patients withRA. The purpose of our investigation was to determine, by a non-invasivemethod such as echocardiography, the nature and extent of cardiacinvolvement in RA patients with no symptoms of cardiac disease,in comparison with a control sample. Methods: We selected 35 patients affected by rheumatoid arthritis(five men, 30 women), aged 51 ± 11 years. No patienthad either symptoms of cardiac disease or extra cardiac complaint. As a control group we studied 52 volunteers, aged 51 ±12 years, randomly selected among a larger group of subjectswith no symptoms, signs and/or clinical findings of extra cardiacdiseases. All were in sinus rhythm and without any cardiac symptom. Standard two-dimensional, M-mode and Doppler echocardiographicexamination was carried out on each subject. Results: In RA patients we found a higher prevalence of severalabnormalities. We found no statistically significant differencesbetween the groups of RA patients based on the stage and durationof disease. We found no correlation between cardiac abnormalitiesand inflammatory indices or drug therapy. Discussion: At least three alterations seem to be typical ofRA patients in the absence of any symptom of cardiac disease:(1) posterior pericardial effusion, (2) aortic root alterationsand (3) valvular thickening. The prevalence of MVP is controversialand needs furtlier investigation. These alterations are variouslycombined in each patient, and for this reason we think thatit is possible to represent such a heart involvement as ‘silentrheumatoid heart disease’. Moreover the knowledge of the presence of unrecognised cardiacabnormalities can be very important for the correct assessmentand management of the RA patient.