Pathogenesis of ischaemic and non-ischaemic heart diseases in rheumatoid arthritis

• Published in: Rheumatic & musculoskeletal diseases open Vol. 6; no. 1; p. e001032
• Main Authors: Błyszczuk, Przemysław, Szekanecz, Zoltan
• Format: Journal Article
• Language: English
• Published: England EULAR 01.01.2020; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Review
• Subjects: Angina pectoris; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Atherosclerosis; Blood clots; Cardiac arrhythmia; Cardiomyopathy; Cardiovascular disease; Cardiovascular system; Causality; Comorbidity; Coronary vessels; Diabetes; Disease Progression; disease-modifying antirheumatic drugs; Health risk assessment; Heart attacks; Heart failure; Heart Failure - epidemiology; Humans; Hypertension; Inflammation; Morbidity; Mortality; Myocardial Ischemia - epidemiology; Pathogenesis; Population; Rheumatoid Arthritis; Risk factors; TNF-alpha; Tumor Necrosis Factor Inhibitors - adverse effects; Tumor Necrosis Factor Inhibitors - therapeutic use; Tumor necrosis factor-TNF; cardiovascular disease; TNF-alpha; inflammation; rheumatoid arthritis; disease-modifying antirheumatic drugs
• ISSN: 2056-5933; 2056-5933
• DOI: 10.1136/rmdopen-2019-001032

Rheumatoid arthritis (RA) is characterised by a chronic inflammatory condition of the joints, but the comorbidities of RA predominantly contribute to the reduced lifespan associated with this disease. Clinical data indicate that cardiovascular disease is the major comorbidity associated with mortality in RA. In this review, we aimed to describe the pathogenesis of heart failure in RA. First, we emphasised the fundamental differences between ischaemic and non-ischaemic heart diseases and referred to their relevance in excessive cardiovascular-dependent mortality in RA. Second, we highlighted aspects of asymptomatic changes in cardiac tissue and in coronary blood vessels that are commonly found in patients with diagnosed RA. Third, we focused on high-grade systemic inflammation as a key trigger of ischaemic and non-ischaemic heart diseases in RA, and described the implication of conventional and biologic antirheumatic medications on the development and progression of heart disease. In particular, we discussed the roles of tumour necrosis factor-alpha (TNF-α) and anti-TNF-α therapies on the development and progression of ischaemic and non-ischaemic heart diseases in RA.