Induction of remission in female rheumatoid arthritis patients is associated with stabilization of myocardial abnormalities: a prospective cardiac magnetic resonance follow-up study

Abstract

Objectives: To study whether female patients with active rheumatoid arthritis (RA) have myocardial abnormalities and whether progression of myocardial involvement can be attenuated by disease-modifying anti-rheumatic drugs (DMARDs).

Method: Cardiac magnetic resonance (cMR; 1.5 or 3.0 T), including late gadolinium enhancement (LGE), T1 relaxation time, and ventricular functions, was performed in 30 patients with untreated active early RA starting first DMARDs, and 28 patients with chronic RA with inadequate response to conventional synthetic DMARDs starting biological DMARDs. cMR was repeated in RA patients 1 year later. cMR was conducted once in 22 fibromyalgia (FM) subjects and in 35 healthy volunteers serving as controls. All subjects were non-smoking females without coronary heart disease, heart failure, or diabetes.

Results: Compared with controls, 58 RA patients had slightly lower ventricular function, although in the normal range, and longer T1 time at baseline. None of the FM subjects had LGE, but it was frequent in RA (67%). During the 1 year DMARD treatment, Disease Activity Score based on 28-joint count–C-reactive protein declined, ventricular functions tended to improve, but the number of patients with LGE remained unchanged. However, the number of LGE-positive heart segments either decreased or stayed the same in 91% of RA patients. In early RA patients, achieving tight remission was associated with LGE stabilization, after adjustment for age, metabolic syndrome, baseline inflammatory activity, and leisure-time physical activity.

Conclusion: Treatment targeted to tight remission in early stages of RA seems to be important to prevent not only joint damage but also myocardial abnormalities.

Acknowledgements

We thank all the participating subjects for their willingness to contribute to the study and their cooperation. Ms Terhi Salonen and Mr Touko Kaasalainen are acknowledged for their excellent technical assistance.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supporting information

Additional supporting information may be found in the online version of this article.

Supplementary figure S1. (S1A) LV segments AHA; (S1B) myocardial LGE distribution according to AHA segments, RA patients, baseline; (S1C) myocardial LGE distribution according to AHA segments, RA patients, follow-up.

Supplementary table S1. Medication of early RA patients.

Supplementary table S2. Medication of chronic RA patients.

Supplementary table S3. Association of late gadolinium enhancement at baseline with DAS28-CRP, age, metabolic syndrome, and leisure-time physical activity in patients with rheumatoid arthritis.

Supplementary table S4. Relationship of tight remission at 1 year with changes in late gadolinium enhancement from baseline to 1 year follow-up in patients with early rheumatoid arthritis.

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Additional information

Funding

This work was supported by the Finnish Medical Foundation (the Finska Läkaresällskapet), the Paulo Foundation, the Competitive State Financing of the Expert Responsibility Area of the Tampere University Hospital, HUS Medical Imaging Center, Liv och Hälsa, Scandinavian Rheumatology Research Foundation, Helsinki University Hospital Research Funds, and the Maire Lisko Foundation.