Cardiac involvement in rheumatoid disease.

The relationship between joint inflammation and heart disease was first suggested by Bouillaud in 1836. In 1891, Charcot described endocarditis and pericarditis in ‘chronic rheumatism’, differentiating cardiac disease in rheumatic fever (rheumatic heart disease) from that in other forms of rheumatism (rheumatoid heart disease (RHD)). It is now clear that cardiac pathology is common in rheumatoid arthritis (RA) (Table 1). This may be important. Cardiovascular mortality accounts for 40–50% of all deaths in RA; it is increased and occurs earlier than in the general population and may associate with the severity of RA1. The reasons for this remain unclear. RHD, although common, rarely has haemodynamic consequences2. Ischaemic heart disease (IHD) is a more likely cause; recent studies suggest similarities of inflammatory pathogenic mechanisms in RA and atherosclerosis, and an increased prevalence of IHD in RA1,3,4.