In the Journals

Myocardial inflammation frequent in RA, linked to disease activity

Isabelle Amigues

Researchers found that subclinical myocardial inflammation occurs frequently in rheumatoid arthritis, is associated with disease activity and could potentially be alleviated with rheumatoid arthritis treatment, according to data published in Arthritis & Rheumatology.

“Patients with RA are at increased risk to develop heart failure,” Isabelle Amigues, MD, of Columbia University College of Physicians and Surgeons, told Healio Rheumatology. “Our study assessed cardiac 18-fluorodeoxyglucose positron emission tomography with computed tomography (FDG PET-CT) in RA patients with no known cardiovascular diseases and found that a significant proportion had FDG uptake, consistent with subclinical myocarditis.”

To analyze the prevalence and correlates of subclinical myocardial inflammation among patients with RA, the researchers studied participants enrolled in the previous Rheumatoid Arthritis Study of the Myocardium — called “RHYTHM” — recruited from rheumatology clinics affiliated with Columbia University Medical Center. Amigues and colleagues focused on 119 adult patients with RA but no known cardiovascular disease, who had undergone FDG PET-CT. They assessed myocardial FDG uptake both visually and quantitatively through standardized uptake values.

 
Subclinical myocardial inflammation occurs frequently in RA, is associated with disease activity and could potentially be alleviated with rheumatoid arthritis treatment, according to data.
Source: Shutterstock

In addition, the researchers used multivariable linear regression to analyze the links between patient characteristics and myocardial standardized uptake values. A subset of eight participants with increasing disease-modifying antirheumatic drug therapy underwent a second FDG PETCT scan after 6 months, to assess treatmentassociated changes in myocardial FDG uptake.

According to the researchers, visually assessed FDG uptake was observed in 37% of the 119 patients with RA included in the study. In addition, 18% demonstrated abnormal quantitatively assessed myocardial FDG uptake. The average standardized uptake values mean was 31% higher for patients with a clinical disease activity index (CDAI) of 10 or greater, compared with those with lower scores (P = .005), after adjusting for potential confounders. The average adjusted standardized uptake values mean was 26% lower among patients treated with nonTNF targeted biologics, compared with those treated with conventional, nonbiologic DMARDs (P = .029).

In addition, in their longitudinal substudy, the researchers found that the myocardial standardized uptake values mean decreased from 4.5 to 2.3 units during a period of 6 months, which corresponded with a decrease in average CDAI from 23 to 12 units.

“Our study supports the hypothesis that myocardial inflammation in RA is related to disease activity and may contribute to the increased risk for heart failure in RA patients,” Amigues said. “Our study supports the concept of treatment to target — ie, remission or minimal disease activity — to achieve articular control as well as prevent further damage to the heart. The finding that disease activity correlated with FDG uptake in the myocardium supports the premise that achieving low disease activity or remission of RA activity protects not only the joints but possibly the myocardium as well.” – by Jason Laday

Disclosure: Amigues reports research support from the NIH. Please see the study for all other authors’ relevant financial disclosures.

Isabelle Amigues

Researchers found that subclinical myocardial inflammation occurs frequently in rheumatoid arthritis, is associated with disease activity and could potentially be alleviated with rheumatoid arthritis treatment, according to data published in Arthritis & Rheumatology.

“Patients with RA are at increased risk to develop heart failure,” Isabelle Amigues, MD, of Columbia University College of Physicians and Surgeons, told Healio Rheumatology. “Our study assessed cardiac 18-fluorodeoxyglucose positron emission tomography with computed tomography (FDG PET-CT) in RA patients with no known cardiovascular diseases and found that a significant proportion had FDG uptake, consistent with subclinical myocarditis.”

To analyze the prevalence and correlates of subclinical myocardial inflammation among patients with RA, the researchers studied participants enrolled in the previous Rheumatoid Arthritis Study of the Myocardium — called “RHYTHM” — recruited from rheumatology clinics affiliated with Columbia University Medical Center. Amigues and colleagues focused on 119 adult patients with RA but no known cardiovascular disease, who had undergone FDG PET-CT. They assessed myocardial FDG uptake both visually and quantitatively through standardized uptake values.

 
Subclinical myocardial inflammation occurs frequently in RA, is associated with disease activity and could potentially be alleviated with rheumatoid arthritis treatment, according to data.
Source: Shutterstock

In addition, the researchers used multivariable linear regression to analyze the links between patient characteristics and myocardial standardized uptake values. A subset of eight participants with increasing disease-modifying antirheumatic drug therapy underwent a second FDG PETCT scan after 6 months, to assess treatmentassociated changes in myocardial FDG uptake.

According to the researchers, visually assessed FDG uptake was observed in 37% of the 119 patients with RA included in the study. In addition, 18% demonstrated abnormal quantitatively assessed myocardial FDG uptake. The average standardized uptake values mean was 31% higher for patients with a clinical disease activity index (CDAI) of 10 or greater, compared with those with lower scores (P = .005), after adjusting for potential confounders. The average adjusted standardized uptake values mean was 26% lower among patients treated with nonTNF targeted biologics, compared with those treated with conventional, nonbiologic DMARDs (P = .029).

In addition, in their longitudinal substudy, the researchers found that the myocardial standardized uptake values mean decreased from 4.5 to 2.3 units during a period of 6 months, which corresponded with a decrease in average CDAI from 23 to 12 units.

“Our study supports the hypothesis that myocardial inflammation in RA is related to disease activity and may contribute to the increased risk for heart failure in RA patients,” Amigues said. “Our study supports the concept of treatment to target — ie, remission or minimal disease activity — to achieve articular control as well as prevent further damage to the heart. The finding that disease activity correlated with FDG uptake in the myocardium supports the premise that achieving low disease activity or remission of RA activity protects not only the joints but possibly the myocardium as well.” – by Jason Laday

Disclosure: Amigues reports research support from the NIH. Please see the study for all other authors’ relevant financial disclosures.