Myocardial Dysfunction and Heart Failure in Rheumatoid Arthritis

Neferine reduces synovial inflammation and cardiac complications in a collagen-induced arthritis mouse model via inhibiting NF-κB/NLRP3 inflammasome axis

For the treatment of rheumatoid arthritis (RA), there are limited options for drugs with fewer side effects. Neferine possesses anti-inflammatory, anti-fibrotic, and cardioprotective properties, but its effectiveness in the treatment of RA remains unclear. Our study aimed to explore the impact of neferine administration on ankle joint inflammation and cardiac complications of collagen-induced arthritis (CIA) mice. The CIA model was introduced in male DBA/1 mice via subcutaneous injection of Type II collagen (CII) into the tail. We found that neferine alleviated ankle joint inflammation, cartilage erosion, and bone destruction, as well as reduced the levels of IL-6, TNF-α, IL-1β, and IL-18 in the serum of CIA mice. Furthermore, neferine reduced the expression of synovial damage markers (RANKL, MMP-3, and MMP-13) in the ankle joints of CIA mice. Mechanistically, neferine lowered the levels of NF-κB pathway-related molecules such as p-IκBα, p-p65, and nuclear p65 in the synovial tissue of CIA mice. Simultaneously, neferine reversed the upregulation of NLRP3, ASC, and cleaved-caspase-1 levels in the synovial tissue of CIA mice. Additionally, our results showed that neferine reduced the contents of myocardial injury markers (cTnI, CK-MB, and LDH), alleviated myocardial fibrosis, decreased expression of α-SMA and Collagen I, as well as mitigated the activation of fibrosis-related TGF-β/Smad signaling. In summary, our study demonstrates that neferine attenuates chondral and synovial inflammation in a CIA mouse model by inhibiting the activation of the NF-κB/NLRP3 inflammasome, and neferine has a protective effect on the hearts of CIA mice.

Evaluating the quality of care for heart failure hospitalizations in inflammatory arthritis - A population-based cohort study

Background

Individuals with inflammatory arthritis (IA) face an elevated risk of heart failure (HF). However, whether the quality of HF care in IA patients differs from other high-risk groups, such as those with diabetes mellitus (DM), remains unclear.

Methods

This population-based cohort study in Ontario, Canada, included patients who experienced their first HF hospitalization and survived to discharge. Patients were categorized into four groups: IA alone, DM alone, IA + DM, and a general population comparator. We assessed quality care measures within 30 days of hospitalization (echocardiogram, electrocardiogram, chest x-ray) and physician follow-up within 7 days. Guideline-directed medical therapy (GDMT) adherence was evaluated within 90 days and classified as perfect, moderate, or poor. Logistic regression was used to determine whether IA was independently associated with lower HF care quality.

Results

Among 101,645 eligible hospitalizations, 1987 had IA + DM, 3849 had IA alone, 33,553 had DM alone, and 62,256 were general comparators. While all groups showed high adherence to testing, IA patients (with or without DM) had significantly lower GDMT use compared to DM patients (p < 0.001). IA was independently linked to lower odds of moderate or perfect GDMT adherence.

Conclusion

Although adherence to HF testing quality measures was high, IA patients were less likely to receive GDMT than those with DM. Further research is needed to understand the reasons for lower GDMT use in IA and its impact on HF outcomes such as re-hospitalization and mortality.

Cannabidiol regulates L-carnitine and butyric acid metabolism by modulating the gut microbiota to ameliorate collagen-induced arthritis

BACKGROUND

Rheumatoid arthritis (RA) is one of the most common autoimmune diseases, affecting multiple systems in the body. Cannabidiol (CBD) is one of the most medically valuable active ingredients in cannabis. At present, CBD has been shown to alleviate the progression of RA; however, owing to its multiple targets, the mechanism of CBD is not clear.

METHODS

On the basis of the gut microbiota, we explored the mechanism by which CBD inhibits RA progression. Metagenomic and nontargeted metabolomic analyses were used to determine the changes in the intestinal ecology and plasma metabolites of collagen-induced arthritis (CIA) rats after CBD treatment.

RESULTS

CBD reversed gut dysbiosis in CIA rats, notably altering the abundances of Allobaculum_unclassified, Allobaculum_fili, and Prevotella_unclassified. In addition, metabolomic analysis confirmed that CBD increased the contents of butyric acid and L-carnitine. Allobaculum could produce butyric acid and Prevotella could accelerate the metabolism of L-carnitine. In addition, in vitro experiments demonstrated that L-carnitine participated in the regulation of neutrophils, macrophages and RA-fibroblast-like synoviocytes (RA-FLSs), which was consistent with the synovial changes in CIA rats caused by CBD.

CONCLUSION

In summary, CBD increased the plasma contents of butyric acid and L-carnitine by altering the abundances of gut microbiota, thereby inhibiting inflammation in neutrophils, macrophages and RA-FLSs. Our study is the first to explain the mechanism by which CBD alleviates progression in CIA rats from the perspective of gut microbes and metabolites, providing new views into CBD mechanisms, which warrants clinical attention.

Risk of Incident Heart Failure and Heart Failure Subtypes in Patients With Rheumatoid Arthritis

OBJECTIVE

Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD) including heart failure (HF). However, little is known regarding the relative risks of HF subtypes such as HF with preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF) in RA compared with non-RA.

METHODS

We identified patients with RA and matched non-RA comparators among participants consenting to broad research from two large academic centers. We identified incident HF and categorized HF subtypes based on EF closest to the HF incident date. Covariates included age, sex, and established CVD risk factors. Cox proportional hazards models were used to estimate the hazard ratios (HRs) for incident HF and HF subtypes.

RESULTS

We studied 1,445 patients with RA and 4,335 matched non-RA comparators (mean age 51.4 and 51.7 years, respectively; 78.7% female). HFpEF was the most common HF subtype in both groups (65% in RA vs 59% in non-RA). Patients with RA had an HR of 1.79 (95% confidence interval [CI] 1.38-2.32) for incident HF compared with those without RA after adjusting for CVD risk factors. Patients with RA had a higher rate of HFpEF (HR 1.99, 95% CI 1.43-2.77), but there was no statistical difference in the HFrEF rate (HR 1.45, 95% CI 0.81-2.60).

CONCLUSION

RA was associated with a higher rate of HF overall compared with non-RA, even after adjustment for established CVD risk factors. The elevated risk was driven by HFpEF, supporting a role for inflammation in HFpEF and highlighting potential opportunities to address this excess risk in RA.

Heart Failure in Rheumatoid Arthritis: Clinical Implications

PURPOSE OF REVIEW

This review focuses on the association between RA and heart failure, highlighting the role of inflammation and the prevalence of heart failure with preserved ejection fraction (HFpEF) in this population.

RECENT FINDINGS

The incidence of heart failure in RA patients is two to three times higher than in the general population, with inflammation playing a significant role independent of traditional cardiovascular risk factors. HFpEF accounts for about half of heart failure cases and is increasingly recognized in RA patients, although it remains underdiagnosed. Atypical presentations and non-specific symptoms further complicate diagnosis. Early control of inflammation has been shown to reduce the risk of heart failure development and progression, improving both morbidity and mortality outcomes. Rheumatoid arthritis (RA) is a systemic inflammatory disease affecting approximately 1% of the population, with cardiovascular disease being the leading cause of premature death in these patients.

Cardiovascular Risk Factors and Echocardiographic Findings in a Predominantly Black Population With Rheumatoid Arthritis and Heart Failure

Among white rheumatoid arthritis (RA) cohorts, heart failure with preserved ejection fraction is the most prevalent type of heart failure (HF). We aimed to assess the type of HF affecting Black RA patients. A total of 64 patients with RA-HF were compared with age-, sex-, and race-matched RA patients without HF. Left ventricular ejection fraction, wall motion abnormalities, left ventricle (LV) mass, and wall thickness were reviewed. About 87.3% were Black and 84.4% were women, with a mean age of 69.6 ± 1.38 (± SEM) and body mass index (kg/m 2 ) of 29.6 ± 1.07. RA-HF patients had higher rates of hypertension (HTN), chronic kidney disease, and atrial fibrillation. However, 66.7% had ≥3 cardiovascular risk factors compared with RA patients without HF. 2D echocardiograms of RA-HF revealed that 62.3% had left ventricular ejection fraction ≥50%, 37% had diastolic dysfunction, and 43.1% had wall motion abnormalities. LV mass and relative wall thickness measurements indicated LV eccentric remodeling. The odds ratio for HF was 4.7 (CI, 1.5-14.53), P < 0.01, among the RA-HTN group and 3.5 (CI, 1.091-11.7) P < 0.01 among smokers. In our predominantly Black RA-HF patients, heart failure with preserved ejection fraction was the most common type of HF. HTN was associated with the highest OR for HF. Eccentric hypertrophic remodeling, a known poor prognostic indicator for cardiovascular events, was found. Further studies are required to confirm our findings.

Cardiac MRI in Rheumatic Disease

Immune-mediated systemic inflammatory disorders present a latent threat for cardiovascular disease. Early involvement may be associated with constitutional symptoms, while clinical evidence of disease may manifest later in an insidious manner. Multimodality imaging is crucial to detect myocardial involvement, with transthoracic echocardiogram as a first-line imaging modality; however, cardiac MRI (CMRI) has the potential to significantly impact our diagnostic and therapeutic approaches through high-fidelity chamber quantification and parametric mapping techniques. Novel imaging techniques are currently under investigation, including stress CMRI, feature tracking CMR, late gadolinium enhancement (LGE) entropy, and 4 dimensional flow CMRI.

Switching from interleukin-6 receptor inhibitors to the direct interleukin-6 inhibitor olokizumab in patients with rheumatoid arthritis: efficacy and safety during one year of therapy

Objective: to investigate the efficacy and safety of olokizumab (OKZ) in patients with rheumatoid arthritis (RA) over a 12-month period after switching from interleukin (IL)-6 receptor inhibitors (iIL6R) for non-medical reasons.

Material and methods. A retrospective cohort study conducted in 11 centers in the Russian Federation included 110 patients with confirmed diagnosis of RA according to 2010 ACR/EULAR criteria. In all patients in early 2022 (due to problems with drug supply during the coronavirus pandemic) iIL6R were switched for non-medical reasons to OKZ at a dose of 64 mg once every 2 weeks or once every 4 weeks in accordance with the instructions for the medical use of OKZ.

Data on clinical efficacy, safety and changes in the dosing regimen of the drugs over an observation period of one year are presented. We assessed the dynamics of the clinical indicators: number of painful and swollen joints, pain on a visual analogue scale and DAS28-ESR/CRP indices. Routine laboratory tests included assessment of red and white blood cells count, ESR, hemoglobin, CRP, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin and cholesterol. Adverse events (AEs) were recorded in accordance with standard practice.

Results and discussion. After 6 months of therapy, the proportion of patients who achieved remission/low disease activity according to DAS28-ESR and DAS28-CRP decreased to 70.1% and 72.9%, respectively, and the proportion of patients with moderate and high activity according to DAS28-ESR increased to 26.1% and 3.7%, respectively, and according to DAS28-CRP to 21.5% and 5.6 %, respectively. After 12 months, remission/low disease activity according to DAS28-ESR and DAS28-CRP was achieved in 81.4% and 83.5% of patients, respectively, and 18.6% and 16.5% of patients had moderate activity.

In the OKZ monotherapy group, after 6 months of treatment 22 (71.0%) patients were in remission/low disease activity according to DAS28-ESR and 23 (74.2%) patients according to DAS28-CRP. After one year of observation, remission/low disease activity according to DAS28-ESR and DAS28-CRP had 24 (88.9%) and 23 (85.2%) patients, respectively.

In the combined therapy group of OKZ + disease-modifying antirheumatic drugs (DMARDs), remission/low disease activity according to DAS28-ESR was observed in 53 (70.7%) patients and according to DAS28-CRP – in 55 (73.3%) patients by the 6th month of therapy. After 12 months, in this group 55 (78.6%) patients showed remission/low disease activity according to DAS28-ESR and according to DAS28-CRP – 58 (82.9 %) patients.

After 6 months, 107 (97.3 %) out of 110 patients included in the study continued treatment. In 1 (0.9%) case OKZ was discontinued due to insufficient effect, in 2 cases contact with the patients was lost. After 12 months, therapy was continued in 97 (88.2%) patients. In 5 (4.5%) cases treatment was discontinued due to insufficient efficacy, in 2 (1.8%) cases – due to increased AST/ALT levels, in another 2 (1.8 %) cases – for non-medical reasons, and in 1 case contact with the patient was lost.

Conclusion. OKZ, a direct IL-6 inhibitor, provided effective control over RA symptoms after switching from iIL6R, which allowed to achieve the treatment goal of maintaining remission/low disease activity over 1 year in more than 80% of patients. OKZ has demonstrated a broad spectrum of capabilities in real-world clinical practice, even when used as monotherapy. In terms of safety profile, OKZ was comparable to other IL6 inhibitors.

Association of congestive heart failure with mortality in individuals with rheumatoid arthritis: a cohort study

OBJECTIVE

Rheumatoid arthritis (RA) is a risk factor for congestive heart failure (CHF). Evidence is lacking regarding the relationship between CHF and mortality among American adults with RA. We aimed to investigate the relationship between CHF and mortality in patients with RA.

METHODS

We extracted the corresponding data from the National Health and Nutrition Examination Survey (NHANES) database and calculated the hazard ratios (HR) and 95% CIs between CHF and mortality from all causes, cardiovascular disease (CVD), and cancer by using a Cox proportional risk model.

RESULTS

A total of 2045 participants with a mean age of 60.32 ± 13.96 years were included; 57.60% were female. During a median follow-up period of 109 months, there were 602 deaths. After adjusting for potential confounders, compared with participants who are non-CHF, those with CHF had 60% (HR 1.60, 95% CI 1.27-2.01) and 110% (1.45, 1.45 to 3.06) higher all-cause mortality and CVD mortality, respectively. Furthermore, a significant association between CHF and all-cause mortality can also be observed in female individuals and those aged 65 and above. There was no significant association between CHF and cancer mortality.

CONCLUSIONS

In this cohort study of US adults with RA, CHF was significantly associated with an increased risk of all-cause or CVD-related death. This finding underscores the importance of CHF in the management of patients with RA and may provide future information on maintaining the health status of patients with RA. Key messages • The study findings demonstrate a significant increase in overall mortality and cardiovascular mortality among individuals with RA who develop CHF. • This knowledge can assist healthcare professionals in identifying high-risk patients who could benefit from targeted monitoring and early intervention to prevent or manage CHF.

A treadmill exercise reduced cardiac fibrosis, inflammation and vulnerability to ischemia-reperfusion in rat pristane-induced arthritis

AIMS

To explore cardiac structural and functional parameters and myocardial sensitivity to ischemia in a rat model of chronic arthritis, pristane-induced arthritis (PIA), and to investigate the effects of a running exercise protocol on cardiac disorders related to rheumatoid arthritis (RA).

MAIN METHODS

3 groups of male Dark Agouti rats were formed: Controls, PIA and PIA-Exercise. The PIA-Exercise group was subjected to an individualized treadmill running protocol during the remission phase. At acute and chronic phases of PIA, cardiac structure was analyzed by histology. Cardiac function was explored in isolated hearts to measure left ventricular developed pressure (LVDP), cardiac compliance and infarct size before and after ischemia/reperfusion. Cardiac inflammation was evaluated through VCAM-1 mRNA expression by RT-qPCR. Plasma irisin levels were measured by ELISA.

KEY FINDINGS

PIA rats exhibited myocardial hypertrophy fibrosis and inflammation at the 2 inflammatory phases of the model. At chronic phase only, LVDP and cardiac compliance were lower in PIA compared to controls. As compared to sedentary PIA, exercise did not change cardiac function but reduced fibrosis, inflammation, infarct size, and arthritis severity and increased irisin levels. Cardiac inflammation positively correlated with fibrosis, while irisin levels negatively correlated with cardiac inflammation and fibrosis.

SIGNIFICANCE

In the PIA model that recapitulated most cardiac disorders of RA, a daily program of treadmill running alleviated cardiac fibrosis and inflammation and improved resistance to ischemia. These data provide arguments to promote the practice of exercise in RA patients for cardiac diseases prevention.

Ultrasound for diagnosis of interstitial lung disease in diffuse connective tissue diseases

Patients with diffuse connective tissue diseases frequently develop interstitial lung disease, which carries a worse prognosis and shortens survival. High-resolution computed tomography is the first-choice test, and is competitive with histopathology, however, the cost and radiation may limit its use, particularly for screening. Lung ultrasound is a rapid, accessible, reproducible, and inexpensive study that is useful for diagnosis of interstitial lung disease. Furthermore, extensive training is not required to identify the alterations associated with these lung diseases. B lines and pleural irregularities compose the ultrasonographic interstitial syndrome, although, it must be kept in mind that it is not specific, and it is necessary to rule out haemodynamic, cardiovascular, and infectious abnormalities. This review highlights the elevated prevalence of this lung condition in the main rheumatological diseases, with emphasis on the usefulness of pulmonary ultrasound.

Chronic β-adrenergic stress contributes to cardiomyopathy in rodents with collagen-induced arthritis

Patients with rheumatoid arthritis (RA) have a much higher incidence of cardiac dysfunction, which contributes to the high mortality rate of RA despite anti-arthritic drug therapy. In this study, we investigated dynamic changes in cardiac function in classic animal models of RA and examined the potential effectors of RA-induced heart failure (HF). Collagen-induced arthritis (CIA) models were established in rats and mice. The cardiac function of CIA animals was dynamically monitored using echocardiography and haemodynamics. We showed that cardiac diastolic and systolic dysfunction occurred in CIA animals and persisted after joint inflammation and that serum proinflammatory cytokine (IL-1β, TNF-α) levels were decreased. We did not find evidence of atherosclerosis (AS) in arthritic animals even though cardiomyopathy was significant. We observed that an impaired cardiac β1AR-excitation contraction coupling signal was accompanied by sustained increases in blood epinephrine levels in CIA rats. Furthermore, serum epinephrine concentrations were positively correlated with the heart failure biomarker NT-proBNP in RA patients (r2 = +0.53, P < 0.0001). In CIA mice, treatment with the nonselective βAR blocker carvedilol (2.5 mg·kg-1·d-1, for 4 weeks) or the specific GRK2 inhibitor paroxetine (2.5 mg·kg-1·d-1, for 4 weeks) effectively rescued heart function. We conclude that chronic and persistent β-adrenergic stress in CIA animals is a significant contributor to cardiomyopathy, which may be a potential target for protecting RA patients against HF.

Genetically Determined Rheumatoid Arthritis May Not Affect Heart Failure: Insights from Mendelian Randomization Study

Background

Evidence from observational epidemiological studies indicated that rheumatoid arthritis (RA) increased the risk of heart failure (HF). However, there is a possibility that the correlation is not explained as a causative role for RA in the pathogenesis of HF. A two-sample Mendelian randomization (MR) framework was designed to explore the potential etiological role of RA in HF to identify the target to improve the burden of HF disease.

Methods

To assess the causal association between RA and HF, we analyzed summary statistics from genome-wide association studies (GWASs) for individuals of European descent. Genetic instruments for RA were identified at a genome-wide significance threshold (p < 5 × 10-8). Corresponding data were obtained from a GWAS meta-analysis (95,524 cases and 1,270,968 controls) to identify genetic variants underlying HF. MR estimates were pooled using the inverse variance weighted method. Complementary analyses were conducted to assess the robustness of the results.

Results

There was no evidence of a causal association between genetically predicted RA and HF [odds ratio (OR), 1.00; 95% confidence interval (CI), 0.99-1.02; P = 0.60]. Various sensitivity analyses suggested no pleiotropy detected (all p > 0.05).

Conclusion

Our findings did not support the causal role of RA in the etiology of HF. As such, therapeutics targeted at the control of RA may have a lower likelihood of effectively controlling the occurrence of HF.

Left ventricular remodeling in rheumatoid arthritis patients without clinical heart failure

Rheumatoid arthritis (RA) patients have a 1.5- to twofold higher risk of developing heart failure (HF) and a twofold increased risk of HF-associated mortality compared to those without RA. HF is preceded subclinically by left ventricular (LV) remodeling in the general population. There is a relative absence of prospective studies following RA patients from pre-clinical to clinical HF as well as prospective studies of LV remodeling in RA without clinical HF. In our study, 158 RA patients without clinical HF were enrolled and underwent transthoracic echocardiography (TTE) at baseline and on follow-up between 4 and 6 years. Extensive characterization of RA disease activity and cardiovascular risk factors were performed. LV remodeling was prevalent at 40% at baseline and increased to 60% over time. Higher levels of interleukin-6 (IL 6) were associated with concentric LV remodeling on follow-up. The use of tocilizumab was also significantly associated with baseline LV remodeling (relative wall thickness). These findings suggest a role for IL-6 as a biomarker for LV remodeling in RA patients without clinical HF. Future research should focus on prospective follow-up of LV remodeling and the effects of IL-6 inhibition on LV remodeling in RA patients.

Rheumatoid arthritis increases the risk of heart failure-current evidence from genome-wide association studies

Background

Numerous studies have demonstrated that rheumatoid arthritis (RA) is related to increased incidence of heart failure (HF), but the underlying association remains unclear. In this study, the potential association of RA and HF was clarified using Mendelian randomization analysis.

Methods

Genetic tools for RA, HF, autoimmune disease (AD), and NT-proBNP were acquired from genome-wide studies without population overlap. The inverse variance weighting method was employed for MR analysis. Meanwhile, the results were verified in terms of reliability by using a series of analyses and assessments.

Results

According to MR analysis, its genetic susceptibility to RA may lead to increased risk of heart failure (OR=1.02226, 95%CI [1.005495-1.039304], P=0.009067), but RA was not associated with NT-proBNP. In addition, RA was a type of AD, and the genetic susceptibility of AD had a close relation to increased risk of heart failure (OR=1.045157, 95%CI [1.010249-1.081272], P=0.010825), while AD was not associated with NT-proBNP. In addition, the MR Steiger test revealed that RA was causal for HF and not the opposite (P = 0.000).

Conclusion

The causal role of RA in HF was explored to recognize the underlying mechanisms of RA and facilitate comprehensive HF evaluation and treatment of RA.

Pathogenesis of Extraarticular Manifestations in Rheumatoid Arthritis-A Comprehensive Review

Rheumatoid arthritis (RA) is among the most prevalent and debilitating autoimmune inflammatory chronic diseases. Although it is primarily characterized by destructive peripheral arthritis, it is a systemic disease, and RA-related extraarticular manifestations (EAMs) can affect almost every organ, exhibit a multitude of clinical presentations, and can even be asymptomatic. Importantly, EAMs largely contribute to the quality of life and mortality of RA patients, particularly substantially increased risk of cardiovascular disease (CVD) which is the leading cause of death in RA patients. In spite of known risk factors related to EAM development, a more in-depth understanding of its pathophysiology is lacking. Improved knowledge of EAMs and their comparison to the pathogenesis of arthritis in RA could lead to a better understanding of RA inflammation overall and its initial phases. Taking into account that RA is a disorder that has many faces and that each person experiences it and responds to treatments differently, gaining a better understanding of the connections between the joint and extra-joint manifestations could help to create new treatments and improve the overall approach to the patient.

Subclinical left ventricular dysfunction and N-terminal pro-brain natriuretic peptide in patients with rheumatoid arthritis

Aim – to determine the frequency of myocardial dysfunction using echocardiography with speckle tracking (STE) method, the relationship between a low global longitudinal strain (GLS) with the level of NT-proBNP, clinical and laboratory manifestations of rheumatoid arthritis. Material and methods. The study included 43 patients with RA (ACR/EULAR criteria, 2010): 79% women, age – 53.0 [38.0; 63.0] years, disease duration – 60.0 [36; 180] months; DAS28 – 5.9 [5.2; 6.4], positive for ACCP (74%), RF IgM (81%), without prior biological therapy and CVD. Methotrexate was received by 44%, leflunomide – 35%, sulfasalazine – 9.3%, hydroxychloroquine – 7%, glucocorticoids – 67.4%, non-steroidal anti-inflammatory drugs – 74% of patients with RA. All RA patients underwent echocardiography – tissue Doppler and STE. The level of NT-proBNP was determined in the blood serum The normal range for NT-proBNP was less than 125 pg/ml.

Results. Low GLS was observed in 26 (61%) patients with RA. RA patients had a decrease GLS, E LV, E’ LV, E/A LV compared with the control group. Left ventricular diastolic dysfunction (LVDD) was higher in RA patients (13 (31%) vs 0%). Patients with RA had significantly higher levels of NT-proBNP (114.8 [45.1; 277.5] and 52 [40.5; 69.1] pg/ml) compared with the control group. There were correlations between a low GLS and DAS28 (r=0.9), the number of painful joints (r=0.6), radiological stage (r=0.6) and the presence of systemic manifestations (r=0.5), age (r=–0.9), E LV velocity (r=–0.5) (p<0.05 in all cases). There were correlations between the level of NT-proBNP and the E/A LV ratio (r=–0.4), A LV velocity (r=0.5) (p><0.05 in all cases).>< 0.05 in all cases). There were correlations between the level of NT-proBNP and the E/A LV ratio (r=–0.4), A LV velocity (r=0.5) (p< 0.05 in all cases).

Conclusions. In RA patients with a high frequency the low GLS LV was detected, which is associated with a high activity of the inflammatory process. STE helps to detect myocardial dysfunction in patients with RA at earlier stages than tissue Doppler. The use of STE, the determination of the level of NT-proBNP make it possible to diagnosing preclinical disorders of systolic and diastolic functions of the LV, which can contribute to the early initiation of therapy and improve the prognosis in this category of patients.

Heart Failure in Chronic Infectious and Inflammatory Conditions: Mechanistic Insights from Clinical Heterogeneity

PURPOSE OF REVIEW

The balance between inflammation and its resolution plays an important and increasingly appreciated role in heart failure (HF) pathogenesis. In humans, different chronic inflammatory conditions and immune-inflammatory responses to infection can lead to diverse HF manifestations. Reviewing the phenotypic and mechanistic diversity of these HF presentations offers useful clinical and scientific insights.

RECENT FINDINGS

HF risk is increased in patients with chronic inflammatory and autoimmune disorders and relates to disease severity. Inflammatory condition-specific HF manifestations exist and underlying pathophysiologic causes may differ across conditions. Although inflammatory disease-specific presentations of HF differ, chronic excess in inflammation and auto-inflammation relative to resolution of this inflammation is a common underlying contributor to HF. Further studies are needed to phenotypically refine inflammatory condition-specific HF pathophysiologies and prognoses, as well as potential targets for intervention.

Prospective changes in diastolic function in patients with rheumatoid arthritis

Background

Diastolic dysfunction (DD) is more prevalent in patients with rheumatoid arthritis (RA) compared to the general population. However, its evolution over time and its significant clinical predictors remain uncharacterized. We report on baseline and prospective changes in diastolic function and its associated RA and cardiovascular (CV) predictors.

Methods

In this study, 158 RA patients without clinical CV disease (CVD) were enrolled and followed up at 4 to 6 years, undergoing baseline and follow-up echocardiography to assess for DD, as well as extensive characterization of RA disease activity and CV risk factors. Novel measures of myocardial inflammation and perfusion were obtained at baseline only. Using baseline and follow-up composite DD (E/e′, Left Atrial Volume Index (LAVI) or peak tricuspid regurgitation (TR) velocity; ≥ 1 in top 25%) as the outcome, multivariable regression models were constructed to identify predictors of DD.

Results

DD was prevalent in RA patients without clinical heart failure (HF) (40.7% at baseline) and significantly progressed on follow-up (to 57.9%). Baseline composite DD was associated with baseline RA disease activity (Clinical Disease Activity Index; CDAI) (OR 1.39; 95% CI 1.02–1.90; p=0.034). Several individual diastolic parameters (baseline E/e′ and LAVI) were associated with troponin-I and brain natriuretic peptide (BNP). Baseline and follow-up composite DD, however, were not associated with myocardial inflammation, myocardial microvascular dysfunction, or subclinical atherosclerosis.

Conclusions

DD is prevalent in RA patients without clinical HF and increases to >50% over time. Higher RA disease activity at baseline predicted baseline composite DD. Future longitudinal studies should explore whether adverse changes in diastolic function lead to clinical HF and are attenuated by disease-modifying antirheumatic drugs (DMARDs).

Supplementary Information

The online version contains supplementary material available at 10.1186/s13075-022-02864-0.

Serum HDAC4 level in rheumatoid arthritis: Longitudinal change during treatment and correlation with clinical outcomes

Objective

Histone deacetylase 4 (HDAC4) modulates immunity, inflammation, and osteoblast differentiation to engage in rheumatoid arthritis (RA) etiology. This study aimed to evaluate the HDAC4 longitudinal change and its relationship with clinical features and outcomes in RA patients.

Methods

Eighty‐three RA patients were enrolled. Their serum HDAC4 level was detected by ELISA at baseline (W0), week (W) 4, W12, and W24 after treatment. RA patients were divided into response or non‐response, low disease activity (LDA) or non‐LDA, remission or non‐remission patients according to their treatment outcomes at W24. Meanwhile, serum HDAC4 was detected by ELISA in 20 osteoarthritis patients and 20 healthy controls (HCs).

Results

HDAC4 level was reduced in RA patients compared with HCs (p < 0.001) and osteoarthritis patients (p = 0.009). HDAC4 was negatively related to some of the disease activity indexes such as C‐reactive protein (p = 0.003), tender joint count (p = 0.025), and disease activity score based on 28 joints (p = 0.013) in RA patients; it was also negatively correlated with TNF‐α (p = 0.003), IL‐6 (p = 0.022), and IL‐17A (p = 0.015). However, the HDAC4 level was not related to different treatment histories or current initiating treatment regimens (all p < 0.05). After treatment, HDAC4 was gradually elevated along with the time (p < 0.001). Interestingly, HDAC4 level at W12 (p = 0.041) and W24 (p = 0.012) was higher in response patients versus non‐response patients, and its level at W24 was higher in LDA patients versus non‐LDA patients (p = 0.019), and in remission patients versus non‐remission patients (p = 0.039).

Conclusion

HDAC4 gradually increases during treatment and its elevation estimates good treatment outcomes in RA patients.

Associations Between Sarcopenia, Heart Failure and Myocardial Infarction in Patients With Systemic Lupus Erythematosus and Rheumatoid Arthritis

Objectives

To evaluate associations between sarcopenia, type of autoimmune disease and risk of heart failure (HF) and myocardial infarction (MI) in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).

Methods

In this population-based, cross-sectional study, discharge data from the 2005–2014 US Nationwide Inpatient Sample (NIS) of hospitalized patients with SLE or RA were extracted and analyzed. Univariate and multivariable regression analyses were conducted to determine associations between sarcopenia, type of autoimmune disease and risk of HF/MI.

Results

After exclusions, 781,199 hospitalized patients diagnosed with SLE or RA were included. Among the study cohort, 127,812 (16.4%) were hospitalized with HF, and 12,781 (1.6%) were hospitalized with MI. Sarcopenia was found in only 0.1% of HF/MI patients. Logistic regression analyses revealed that sarcopenia was not significantly associated with presence of either HF or MI. Patients with RA had significantly lower odds of HF than SLE patients (aOR = 0.77, 95%CI: 0.76, 0.79) or MI (aOR = 0.86, 95%CI: 0.82, 0.91).

Conclusion

In the US, among hospitalized adults diagnosed with SLE or RA, patients with RA are significantly less likely to have HF or MI than those with SLE. Whether sarcopenia leads to increased HF or MI remains inconclusive. Further studies are warranted to investigate the pathophysiology underlying discrepancies between RA and SLE regarding risk for MI or HF.