CARDIAC INVOLVEMENT IN RHEUMATOID-ARTHRITIS - EVIDENCE OF SILENT HEART-DISEASE

Background: Rheumatoid arthritis (RA) is a systemic disease involving many organ systems and is frequently accompanied by cardiac alternatio ns. However, there is considerable disagreement concerning the cardiac abnormalities found in patients with RA. The purpose of our investiga tion was to determine, by a non-invasive method such as echocardiograp hy, the nature and extent of cardiac involvement in RA patients with n o symptoms of cardiac disease, in comparison with a control sample. Me thods: We selected 35 patients affected by rheumatoid arthritis (five men, 30 women), aged 51 +/- 11 years. No patient had either symptoms o f cardiac disease or extra cardiac complaint. As a control group we st udied 52 volunteers, aged 51 +/- 12 years, randomly selected among a l arger group of subjects with no symptoms, signs and/or clinical findin gs of extra cardiac diseases. All were in sinus rhythm and without any cardiac symptom. Standard two-dimensional, M-mode and Doppler echocar diographic examination was carried out on each subject. Results: In RA patients we found a higher prevalence of several abnormalities. We fo und no statistically significant differences between the groups of RA patients based on the stage and duration of disease. We found no corre lation between cardiac abnormalities and inflammatory indices or drug therapy. Discussion: At least three alternations seem to be typical of RA patients in the absence of any symptom of cardiac disease: (1) pos terior pericardial effusion, (2) aortic root alterations and (3) valvu lar thickening. The prevalence of MVP is controversial and needs furth er investigation. These alterations are variously combined in each pat ient, and for this reason we think that it is possible to represent su ch a heart involvement as 'silent rheumatoid heart disease'. Moreover the knowledge of the presence of unrecognised cardiac abnormalities ca n be very important for the correct assessment and management of the R A patient.