Columbia University College of Physicians and Surgeons, and New York Presbyterian Hospital, New York, New York.
Arthritis Rheumatol. 2019 Apr;71(4):496-506. doi: 10.1002/art.40771. Epub 2019 Feb 28.
To determine the prevalence and correlates of subclinical myocardial inflammation in patients with rheumatoid arthritis (RA).
RA patients (n = 119) without known cardiovascular disease underwent cardiac 18-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET-CT). Myocardial FDG uptake was assessed visually and measured quantitatively as the standardized uptake value (SUV). Multivariable linear regression was used to assess the associations of patient characteristics with myocardial SUVs. A subset of RA patients who had to escalate their disease-modifying antirheumatic drug (DMARD) therapy (n = 8) underwent a second FDG PET-CT scan after 6 months, to assess treatment-associated changes in myocardial FDG uptake.
Visually assessed FDG uptake was observed in 46 (39%) of the 119 RA patients, and 21 patients (18%) had abnormal quantitatively assessed myocardial FDG uptake (i.e., mean of the mean SUV [SUV ] ≥3.10 units; defined as 2 SD above the value in a reference group of 27 non-RA subjects). The SUV was 31% higher in patients with a Clinical Disease Activity Index (CDAI) score of ≥10 (moderate-to-high disease activity) as compared with those with lower CDAI scores (low disease activity or remission) (P = 0.005), after adjustment for potential confounders. The adjusted SUV was 26% lower among those treated with a non-tumor necrosis factor-targeted biologic agent compared with those treated with conventional (nonbiologic) DMARDs (P = 0.029). In the longitudinal substudy, the myocardial SUV decreased from 4.50 units to 2.30 units over 6 months, which paralleled the decrease in the mean CDAI from a score of 23 to a score of 12.
Subclinical myocardial inflammation is frequent in patients with RA, is associated with RA disease activity, and may decrease with RA therapy. Future longitudinal studies will be required to assess whether reduction in myocardial inflammation will reduce heart failure risk in RA.
确定类风湿关节炎（RA）患者亚临床心肌炎症的患病率和相关因素。
119 例无已知心血管疾病的 RA 患者接受心脏 18-氟脱氧葡萄糖（FDG）正电子发射断层扫描与计算机断层扫描（PET-CT）。通过视觉评估心肌 FDG 摄取，并以标准化摄取值（SUV）进行定量测量。多变量线性回归用于评估患者特征与心肌 SUVs 的相关性。RA 患者亚组需要升级疾病修饰抗风湿药物（DMARD）治疗（n=8），在 6 个月后进行第二次 FDG PET-CT 扫描，以评估治疗相关的心肌 FDG 摄取变化。
119 例 RA 患者中有 46 例（39%）观察到 FDG 摄取异常，21 例（18%）定量评估的心肌 FDG 摄取异常（即平均 SUV [SUV]≥3.10 单位；定义为参考组 27 例非 RA 患者值的 2 SD 以上）。与疾病活动度较低（低疾病活动或缓解）的患者相比，临床疾病活动指数（CDAI）评分≥10（中高度疾病活动）的患者 SUV 高 31%（P=0.005），校正潜在混杂因素后。与使用传统（非生物）DMARD 治疗的患者相比，使用非肿瘤坏死因子靶向生物制剂治疗的患者 SUV 低 26%（P=0.029）。在纵向亚研究中，心肌 SUV 从 4.50 单位降至 6 个月时的 2.30 单位，与 CDAI 平均值从 23 分降至 12 分的下降相一致。
RA 患者存在亚临床心肌炎症，与 RA 疾病活动度相关，且可能随 RA 治疗而降低。需要进一步进行纵向研究，以评估心肌炎症减少是否会降低 RA 患者的心力衰竭风险。
