Heart Failure Symptoms More Subtle in Rheumatoid Arthritis

FRIDAY, Oct. 3 (HealthDay News) -- Rheumatoid arthritis patients are less likely to experience typical heart failure symptoms, but are more likely to experience a myocardial infarction with corticosteroid use, according to two reports published in the October issue of Arthritis & Rheumatism.

In one study, John M. Davis III, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues performed a community-based cohort study in Olmsted County, Minn. comparing clinical presentation, management and outcomes of heart failure patients with co-morbid rheumatoid arthritis patients. Among 103 patients with rheumatoid arthritis and 852 participants without rheumatoid arthritis, the rheumatoid arthritis patients were less likely to be obese, hypertensive or to have ischemic heart disease. Patients diagnosed with rheumatoid arthritis and heart failure experienced fewer typical symptoms and signs and were less likely to undergo echocardiography. "Mortality at one year following heart failure diagnosis was higher in patients with rheumatoid arthritis compared with non-rheumatoid arthritis patients (35 percent versus 19 percent)," the authors report.

"Perhaps most importantly, we have shown that patients with rheumatoid arthritis experience significantly higher mortality following the onset of heart failure compared with non-rheumatoid arthritis patients, despite lower rates of hypertension, ischemic heart disease, and obesity in rheumatoid arthritis patients," Davis and colleagues write.

In the second report, Frederick Wolfe, M.D., and a colleague at the National Data Bank for Rheumatic Diseases in Wichita, Kan., conducted a cohort study of myocardial infarction in 17,738 patients with rheumatoid arthritis and 3,001 patients with non-inflammatory rheumatic disorders. Myocardial infarction was 1.9 times more common in the rheumatoid arthritis patients compared to the non-inflammatory rheumatic disorder group. This effect was lessened when corticosteroid users were eliminated, the report indicates.

The National Data Bank and an author in the first study have financial ties to pharmaceutical companies.

Davis Abstract
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Wolfe Abstract
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