Purpose: Rheumatoid arthritis (RA) refers to diseases that increase the risk of cardiovascular disease, including chronic heart failure (CHF). CHF in patients with RA develops due to systemic damage, presence of concomitant cardiovascular disease and influence of anti-rheumatic therapy, mainly glucocorticoids (GC). The purpose of this study was to analyze the clinical features of CHF in patients with RA and to assess the association of this phenomenon with severity of RA (activity, progressive course, systemic manifestations), presence of concomitant arterial hypertension (AH), coronary heart disease (CHD), GC treatment duration.
Methods: We observed 96 patients (82 female and 14 male) with a significant clinical signs of RA and CHF functional class (FC) 2-3 (NYHA) in age from 42 to 74 years, mean age 58.34 ± 4.56 years. All participants underwent a standard examination for verification of CHF, as recommended by the ESC 2012. Along with this we analyzed the association of CHF with RA activity and duration, presence of erosive arthritis, extra-articular manifestations, levels of laboratory markers of inflammation, duration of GC therapy, as well as the degree of blood pressure elevation and clinical manifestation of coronary artery disease.
Results: Systolic dysfunction was found in 11 patients, the remaining 85 patients had myocardial structural damage and / or signs of diastolic dysfunction. Related hypertension was diagnosed in 71 patients, clinical signs of coronary artery disease were determined in 43 patients, with no significant differences in the severity of CHF in patients depending on the presence of CHD. We revealed a direct relationship between the activity, duration and the presence of systemic manifestations of RA on the one hand and the FC of heart failure - on the other. In the group of RA patients without clinical signs of CHD BNP levels correlated with the levels of CRP and pro-inflammatory cytokines. Systolic dysfunction was observed predominantly in patients with long standing (>10 years) progressive RA who had been treated by systemic GC.
Conclusions: Thus, high disease activity in long standing erosive RA and GC treatment were the most significant factors associated with CHF and contribute to the development of systolic dysfunction.