RESEARCH - Raised sed rate signals heart failure in patients with RA

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ls of the Rheumatic Diseases 2007;66:76-80

© 2007 by BMJ Publishing Group Ltd & European League Against Rheumatism

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EXTENDED REPORT

Raised erythrocyte sedimentation rate signals heart failure in patients with

rheumatoid arthritis

H Maradit-Kremers, P J Nicola, C S Crowson, K V Ballman, S J sen, V L

and S E

Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota,

USA

Background: Inflammatory markers are associated with heart failure. Patients

with rheumatoid arthritis have twice the risk of heart failure compared with

people without rheumatoid arthritis.

Objective: To assess whether heart failure in patients with rheumatoid

arthritis is preceded by an inflammatory activation as shown by erythrocyte

sedimentation rate (ESR), a systemic marker of inflammation.

Methods: A population-based inception cohort of 575 patients with rheumatoid

arthritis, free of heart failure at their rheumatoid arthritis incidence

date, was followed up longitudinally until death or 2001. During 15 years of

follow-up, they had a median of 15 ESR tests, and 172 patients had new-onset

heart failure (Framingham Heart Study criteria). The follow-up period,

beginning with the rheumatoid arthritis incidence date and ending with date

of the last follow-up, was divided into 6-month intervals. The proportions

of patients with at least one ESR value 40 mm/h and with anaemia

(haemoglobin <11 g/dl) within each 6-month interval were plotted against

time from fulfilment of heart failure criteria. A binomial test was used to

compare proportions.

Results: In patients with rheumatoid arthritis who developed heart failure,

the proportion with ESR 40 mm/h was highest (23%) during the 6-month period

immediately preceding the new-onset heart failure, as compared with the

average ESR during the entire remaining follow-up period, both before and

after heart failure (10.6%; p<0.01). The proportion of patients with anaemia

peaked (54%) during the 6-month period after heart failure.

Conclusions: Inflammatory stimuli may be involved in the initiation of heart

failure among patients with rheumatoid arthritis.

http://ard.bmj.com/cgi/content/abstract/66/1/76?etoc

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s Hopkins Medicine

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