Increased Prevalence of Diastolic Heart Failure in Patients with Rheumatoid Arthritis Correlates with Active Disease, but Not with Treatment Type

Schau, Thomas; Gottwald, M.; Arbach, Olga; Seifert, Martin; Schöpp, Maren; Neuß, Michael; Butter, Christian; Zänker, Michael

doi:10.3899/jrheum.141647

Cited by 44 publications

(61 citation statements)

References 54 publications

(76 reference statements)

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“…There are conflicting results from previous studies that investigated connections between diastolic dysfunction and RA. While some trials concluded that there are correlations between left ventricular diastolic dysfunction and RA, other trials reported no significant correlations regarding the two conditions . The present RA population exhibited a median E/A ratio below one while the median e’ was within the normal range, suggesting a grade 1 diastolic dysfunction (impaired relaxation).…”

Section: Discussioncontrasting

confidence: 56%

Enhanced ventricular‐arterial coupling during a 2‐year physical activity programme in patients with rheumatoid arthritis: a prospective substudy of the physical activity in rheumatoid arthritis 2010 trial

et al. 2017

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Section: Discussioncontrasting

confidence: 56%

Enhanced ventricular‐arterial coupling during a 2‐year physical activity programme in patients with rheumatoid arthritis: a prospective substudy of the physical activity in rheumatoid arthritis 2010 trial

et al. 2017

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“…Additionally, RA-related parameters (patient's disability, pain, severity of RA, RF positivity) were associated with prevalent HF [16,45]. Disease activity is also considered to be an independent risk factor of HF as well as systemic inflammation (ESR, CRP) or duration of RA [46,47]. Besides several RA characteristics, the use of GC was also associated with HF after adjustment for CV risk factors and CHD.…”

Section: Rheumatoid Arthritis and Heart Failurementioning

confidence: 95%

“…In the study of Bhatia et al, the prevalence of systolic dysfunction was three times more common as compared to general population [57]. In some studies, HF in RA has been associated with concentric LV hypertrophy and reduced longitudinal strain [46,47].…”

Section: Rheumatoid Arthritis and Heart Failurementioning

confidence: 98%

Cardiac Impairment in Rheumatoid Arthritis and Influence of Anti-TNFα Treatment

Lazúrová

Tomáš

2016

Clinic Rev Allerg Immunol

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There is evidence that rheumatoid arthritis (RA) is associated with higher overall and cardiovascular (CV) morbidity and mortality as compared with general population. Increased prevalence of traditional risk factors and chronic inflammation, that has been recognized as independent CV risk factor, may play an important role in atherosclerosis and subsequently ischemic heart disease development. However, myocardial dysfunction as a result of chronic inflammation and secondarily myocardial fibrosis markedly participates on heart failure development. Proinflammatory cytokines, such as C-reactive protein, tumor necrosis factor alpha (TNFα), interleukins 1 and 6, that are markedly increased in RA, play a role in the acceleration of atherosclerosis as well as myocardial fibrosis development. Several studies documented that increased CV risk was associated with seropositivity, disease activity score, citrullination, and duration of RA. Early detection of heart dysfunction is based on echocardiographic detection of diastolic dysfunction resulting from myocardial inflammation and fibrosis. Some studies showed also higher prevalence of left ventricular systolic dysfunction and increased prevalence of cardiac arrhythmias as compared to non-RA population. There are still controversies on the impact of NT-proBNP in predicting cardiac impairment in RA patients. Some authors consider it to be a sensitive noninvasive predictor of subclinical CV disease in these patients and also a predictor of all-cause mortality independently on traditional CV risk factors. However, the correlation with parameters of cardiac function was confirmed only in a few studies. The impact of biological treatment on progression of atherosclerosis and heart failure is still controversial and seems to be not harmful in young patients with normal left ventricular function. The effect of biologics, especially anti-TNFα drugs, is probably related to the cardiac function before treatment. Larger prospective clinical, echocardiographic, and magnetic resonance studies are needed.

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“…Of note, RA, independently of treatment strategies, is associated with higher risk of heart failure, higher disease activity and disease duration of more than 10 years being independent risk factors [76]. In a subgroup analysis Solomon et al showed that the heart failure risk in the elderly RA patients (>65 y.o.)…”

Section: 12tolerability and Safetymentioning

confidence: 99%

Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance

Ishchenko

Lories

2016

Drugs Aging

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The population of elderly individuals with rheumatoid arthritis is rapidly expanding, mainly due to the increased life expectancy. While targeted biological therapies are well established for the treatment of this disease, their use may be lower in elderly (> of 65 years old) and very elderly patients (> 75 years old) due to perceived higher risks for adverse events in this population taking into account comorbidity, polypharmacy and frailty. In this review we discuss available evidence for the use of biological therapies in this growing patient group with specific attention towards eventual reasons for biological treatment failure or withdrawal. The majority of data is found in secondary analyses of clinical trials and in retrospective cohorts. Most information is available about tumor necrosis factor (TNF) blockers. Older patients seem to have a less robust response to anti-TNF agents than a younger population, but drug survival that may considered a proxy for efficacy does not seem to be influenced by age. Despite an overall rate of adverse effects comparable to that in younger patients, elderly RA patients are at higher risk of serious infections. Other biologics appear to have an efficacy similar to anti-TNF agents, also in the elderly RA patients. Again, the drug survival rates for tocilizumab, rituximab and abatacept resemble those in young RA patients with good general tolerability and safety profiles. The cardiovascular risk and the risk of cancer, increased in RA patents and in the elderly patients, do not appear to be strongly influenced by biologicals. Key points-Biological drugs targeting specific cytokines or immune cell populations are an important part of the management strategy for rheumatoid arthritis patients, including the elderly. 3-Overall safety and tolerability in the elderly patients is very good and age should not be a critical factor to decide against biological drug use.-The drug survival rate of biologicals in the elderly RA patients is comparable to that in the young RA population.-Co-morbidities and risk of infection are important variables to assess when considering a biological drug in the elderly.-More data and specific studies are required to better position biological drug use in this particular population as current studies provide a low level of evidence. Data in patients above 75 years are still largely missing. Moreover, the group of elderly patients that were included in clinical trials may be influenced by selection bias at inclusion and not be fully representative for infections risks and other comorbidities.4

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Increased Prevalence of Diastolic Heart Failure in Patients with Rheumatoid Arthritis Correlates with Active Disease, but Not with Treatment Type

Abstract: Recognition of all diastolic HF in RA requires a complex diagnostic approach. Active rather than inactive RA places patients at a higher risk for HF, whereas influence of RA treatment on HF risk needs to be elucidated in further studies.

Cited by 44 publications

References 54 publications

Enhanced ventricular‐arterial coupling during a 2‐year physical activity programme in patients with rheumatoid arthritis: a prospective substudy of the physical activity in rheumatoid arthritis 2010 trial

Enhanced ventricular‐arterial coupling during a 2‐year physical activity programme in patients with rheumatoid arthritis: a prospective substudy of the physical activity in rheumatoid arthritis 2010 trial

Cardiac Impairment in Rheumatoid Arthritis and Influence of Anti-TNFα Treatment

Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance

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