Inflammation of the Heart Muscle Tissue in Patients with Rheumatoid Arthritis

Overview

About this study

Rheumatoid arthritis (RA) patients have a higher prevalence of subclinical atherosclerosis than the general population. In addition, they experience higher rates of heart failure with preserved ejection fraction (HFpEF). There is evidence that myocardial mechanics and left ventricular diastolic function are more abnormal in the RA population and these changes occur earlier than in the general population. Recently a study suggested that RA patient have abnormal myocardial inflammation during a disease flare and that this is improved with anti-inflammatory treatment. Our study is aimed at describing the prevalence of myocardial inflammation in patients during active RA disease flares and comparing that with RA patients who are in remission. We hope to show that abnormalities in myocardial inflammation on PET imaging correlate with abnormalities in myocardial strain on echocardiography. Coronary CT will be performed to establish the presence of subclinical atherosclerosis and whether its presence affects changes in either myocardial inflammation or myocardial strain. The hypothesis is that patients with evidence of myocardial inflammation during the course of their RA disease are more likely to develop HFpEF during their lifetime. Although the present study will not be of a duration to assess outcome, we will provide descriptive data which may help guide future prospective study of patients with RA which may help guide appropriate cardiovascular testing in this high risk population.

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

Inclusion Criteria:

  • Diagnosis of Rheumatoid Arthritis according to 2010 American College of Rheumatology (ACR) criteria.
  • RA disease duration ≤ 10 years since diagnosis.
  • CDAI Score of either ≤ 2.8 (low disease activity) or >10 (moderate-to-high disease activity).
  • ≥ 40 years of age.
  • Able to provide informed consent.

Exclusion Criteria:

  • Known clinical atherosclerotic disease (myocardial infarction, severe obstruction CAD (≥ 1 untreated stenosis (≥ 70% in a major vessel) known by either invasive or noninvasive testing), prior coronary artery intervention, prior coronary artery bypass surgery, cerebrovascular event, peripheral vascular disease).
  • Prednisone >10mg per day (or equivalent corticosteroid dose per day within last week).
  • Irregular heart rhythm (arrhythmia or cardiac conduction abnormality (i.e., atrial fibrillation or flutter, frequentextrasystole, LBBB).
  • Relevant valvular heart disease (> moderate regurgitation or stenosis of any heart valve).
  • Clinical occurrence of heart failure with or without preserved ejection fraction.
  • Impaired imaging quality or others contraindications for myocardial strain imaging.
  • Relevant lung disease (including COPD, fibrosis, symptomatic pleural effusion, oxygen dependence).
  • Sarcoidosis.
  • Diabetes mellitus treated with insulin.
  • Estimated glomerular filtration rate (eGFR) < 40ml/min.
  • Known cancer.
  • History of any-type of cardiomyopathy (i.e., cardiac amyloidosis, hypertrophic cardiomyopathy ...).
  • Ejection fraction (EF) less than 45%.
  • Life expectancy < 1 year.
  • BMI > 40kg/m^2.
  • Severe claustrophobia.
  • Any known allergic reactions to intravenous contrast.
  • Inability to receive beta blocker therapy or IV nitrates.
  • Pregnant / breastfeeding women.
  • Vulnerable persons due to Helsinki Declaration.
  • Unable to provide informed consent.

Participating Mayo Clinic locations

Study statuses change often. Please contact the study team for the most up-to-date information regarding possible participation.

Mayo Clinic Location Status Contact

Rochester, Minn.

Mayo Clinic principal investigator

Rekha Mankad, M.D.

Open for enrollment

Contact information:

Jane McGlinch B.S.

(507)538-6123

McGlinch.Jane@mayo.edu

More information

Publications

Publications are currently not available

Study Results Summary

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Supplemental Study Information

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