Rheumatoid Arthritis and Heart Disease

Buzzwords
  • Pancarditis
    • Mitral involvement is common – Nodules
    • pericarditis most common reported
    • Myocardial – increase ischemic and non ischemic

Pericarditis

less than 10 percent

most frequently in patients with active rheumatoid disease and other extraarticular manifestations.

Myocarditis

Myocarditis  usually associated with active articular disease

granulomatous fibrotic  (more common in RA 46% )

 involvement of the endocardium can cause MR

involvement of the conduction system can cause AV block

interstitial, (more common in SLE)

 and with other nonarticular manifestations [49].

Myocardial abnormalities, were frequent in RA patients without known cardiac disease associated with higher RA disease activity, Inflammation in the pathogenesis of myocardial involvement in RA is implied

Valvular Disease

Rheumatoid nodules causing regurgitation

 

CAD

Ischemic cardiomyopathy rheumatoid vasculitis

increased risk – steroids

Conduction defects

Rheumatoid nodules causing

Amyloidosis

long standing effects

Drug Induced

Chloroquin and quinolones

MRI

Buzz

    •  patchy,
    • mid-wall pattern,
    • inferolateral
PATTERN OF LGE IN RA, SLE and SCLERODERMA 
Ntusi et al Myocardial tissue characterisation with late gadolinium enhancement in rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis
J Cardiovasc Magn Reson. 2013; 15(Suppl 1): O47.

 

RHEUMATOID ARTHRITIS AND LGE PATTERNS
LGE noted as a linear pattern in mid myocardium on the inferolateral wall
Aisha T. Langford, Myocardial Inflammation Detected in Once Heart-Healthy RA Patients Cardiovascular Disease in RheumatologyRheumatoid Arthritis  January 19, 2017
RHEUMATOID ARTHRITIS AND LGE PATTERNS
LGE noted as a linear pattern in mid myocardium on the anterior wall. linear
Aisha T. Langford, Myocardial Inflammation Detected in Once Heart-Healthy RA Patients Cardiovascular Disease in RheumatologyRheumatoid Arthritis  January 19, 2017
RHEUMATOID ARTHRITIS AND LGE PATTERNS
LGE noted as nodular and linear changes in the mid myocardium and to some extent in the subendocardial and subepicardial regions extending the entire circumference
The second image shows diffuse T2 hyperintensity of the LV myocardium
Aisha T. Langford, Myocardial Inflammation Detected in Once Heart-Healthy RA Patients Cardiovascular Disease in RheumatologyRheumatoid Arthritis  January 19, 2017
RHEUMATOID ARTHRITIS AND LGE PATTERNS
LGE noted as patchy nodular changes in the mid layer of the septum
Aisha T. Langford, Myocardial Inflammation Detected in Once Heart-Healthy RA Patients Cardiovascular Disease in RheumatologyRheumatoid Arthritis  January 19, 2017
PATTERN OF LGE IN RA, SLE and SCLERODERMA 
Ntusi et al Myocardial tissue characterisation with late gadolinium enhancement in rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis
J Cardiovasc Magn Reson. 2013; 15(Suppl 1): O47.

References and Links

Aisha T. Langford, Myocardial Inflammation Detected in Once Heart-Healthy RA Patients Cardiovascular Disease in RheumatologyRheumatoid Arthritis  January 19, 2017

Ntusi et al Myocardial tissue characterisation with late gadolinium enhancement in rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis
J Cardiovasc Magn Reson. 2013; 15(Suppl 1): O47.