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Cardiac changes in rheumatoid arthritis
M Bély1, A Apáthy, E Beke-Martos
1National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.
Insights
Rheumatoid arthritis (RA) significantly impacts the heart, causing vasculitis, myocardial infarctions, and amyloidosis in a notable percentage of patients. These cardiac complications, including rheumatoid nodules, can be severe and directly contribute to mortality.
Area of Science:
- Cardiovascular Pathology
- Rheumatology
- Autopsy Studies
Background:
- Rheumatoid arthritis (RA) is a systemic autoimmune disease with known extra-articular manifestations.
- Cardiac involvement in RA is increasingly recognized but requires detailed pathological examination.
Purpose of the Study:
- To investigate the spectrum and prevalence of cardiac pathological changes in patients with rheumatoid arthritis.
- To determine the association between rheumatoid arthritis, vasculitis, rheumatoid nodules, and cardiac dysfunction.
Main Methods:
- Autopsy review of 169 patients diagnosed with rheumatoid arthritis.
- Systematic examination of cardiac tissues for vasculitis, myocardial infarction, rheumatoid nodules, pericarditis, valvulitis, and amyloidosis.
Main Results:
- Systemic vasculitis was identified in 15.38% of RA patients; coronary vessel vasculitis occurred in 10%.
- Myocardial infarctions linked to coronary arteritis were observed in 5.9% of cases, leading to cardiac insufficiency and death.
- Rheumatoid nodules in the myocardium (8 cases), pericarditis (4 cases), and valvulitis (7 cases) were significant findings, with nodules potentially representing severe vasculitis.
- Generalized secondary amyloidosis was present in 18.93% of patients, predominantly affecting the heart (90.62% of amyloidosis cases).
Conclusions:
- Cardiac pathology, including vasculitis and rheumatoid nodules, is a frequent and severe complication of rheumatoid arthritis.
- Amyloidosis is a significant contributor to cardiac morbidity in RA patients.
- These findings underscore the importance of monitoring cardiac health in individuals with rheumatoid arthritis.
Abstract:
We reviewed the autopsy material of 169 patients with rheumatoid arthritis (RA) and studied the cardiac changes is these patients. Systemic vasculitis was observed in 26 cases (15.38%) among 169 patients with RA. In 17 cases (10%) we found vasculitis of the subepicardial and/or intramural coronary vessels. Coronary arteritis or arteriolotis has led to multifocal small, and/or large myocardial infarctions in 10 cases (5.9%) and was the cause of progressive cardiac insufficiency, the direct cause of death. Multifocal circumscribed myocardial infarction reported in rheumatoid disease. In 8 cases rheumatoid nodules were found in the myocardium, 3 of them related to vasculitis. We suggest that rheumatoid nodules are the most severe form of necrotizing granulomatous vasculitis. Pathognomic nodular rheumatoid pericarditis was seen in 3 cases and diffuse rheumatoid pericarditis in another case. Pathognomic nodular valvulitis was found in 7 cases. Rheumatoid nodules localized to the epi-, myo-, or endocardium were observed on 9 patients. Generalized secondary amyloidosis was observed in 32 (18.93%) of the 169 patients with RA. Secondary amyloidosis was prevalent in the heart in 29 of 32 cases (relative frequency: 90.62%).