Evaluation of the Cardiac Effects of Inflammation in Patients with Rheumatoid Arthritis and Spondyloarthritis.

Background

This study aimed to evaluate cardiac involvement during active inflammation in 2 pathophysi- ologically different diseases, rheumatoid arthritis (RA) and ankylosing spondylitis (AS), and the change in cardiac involvement with suppression of inflammation after effective treatment.

Methods

The study involved 30 newly diagnosed, active RA and 31 active AS patients in need of biologi- cal treatment. The patients were evaluated by the same cardiologist using pulse wave Doppler and tissue Doppler echocardiography at the beginning of the study and after 3 months of treatment. Myocardial per- formance index (MPI) was obtained by dividing the sum of isovolumetric relaxation time and isovolumetric contraction time, calculated from the recorded Doppler tracing, by ejection time (ET) from the same tracing was calculated separately for both ventricles.

Results

It was found that diastolic dysfunction was present at the time of diagnosis and did not improve after treatment, despite regression in inflammatory values and joint findings. In the pre-treatment period, MPI was found to be higher than the normal value range in both groups. The MPI was 0.5 ± 0.07 for RA patients and 0.51 ± 0.1 for AS patients. No significant difference was found between the 2 groups before treatment (P=.697). In the post-treatment evaluation, no significant difference was found in RA and AS patients compared to pretreatment.

Conclusion

Inflammation-induced cardiac involvement may develop in both RA and AS patients, despite their different pathophysiologic pathways. Longer follow-up periods are necessary for the improvement of inflammation-induced diastolic dysfunction and MPI values compared to joint findings used in activation parameters.