Heart Failure Associated with Rheumatoid Arthritis

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints. Extra-articular features are very common. We report a case of RA first diagnosed after an episode of congestive heart failure (CHF) and the evolution of left ventricular function after conventional treatment of CHF and immunosuppressive drugs. The patient, a 52-year-old man, with history of epilepsy and a stroke 6 years before, presented to the emergency department with increasing dyspnea. He had polyarthralgia 2 months before. The lower extremities had mild pitting edema. The musculoskeletal examination revealed synovial thickening of the metacarpophalangeal and proximal interphalangeal joints, but there was no joint tenderness. The patient’s alanine aminotransferase, troponin levels and CRP were slightly elevated. His renal function was preserved. The electrocardiogram (EKG) was normal. An echocardiogram performed in showed a global hypokinetic dilated cardiomyopathy with an ejection fraction of 15–20%, with apical thrombus. The patient was diagnosed with exacerbation of congestive heart failure (CHF) and was treated with intravenous diuretics. This led to symptomatic improvement.  He got a conventional heart failure treatment with vit K antagonists. Coronarography was normal. Viral serologies were negative. The martial, phosphocalcic and thyroid markers were normal. However, the immunologic tests showed positive rheumatoid factor and anti-CCP. The diagnosis of dilated cardiomyopathy due to rheumatoid arthritis was retained. The patient was treated by corticosteroids and immunosuppressive agents. Patient was seen during routine follow-up after 6 months. Interestingly, echocardiographic findings were totally normal with left ventricular ejection fraction >50% and normal LV size.