Myocardial Perfusion Does Not Differ Between Patients With Untreated RA and Healthy Individuals

Myocardial perfusion values did not differ between treatment-naive patients with early rheumatoid arthritis (RA) and healthy control participants, according to study findings published in Arthritis & Rheumatology.

Patients with RA demonstrate an increased risk of developing coronary artery disease, secondary to inflammation, resulting in myocardial microvascular dysfunction.

Researchers at Biomedical Research Center retrospectively analyzed myocardial perfusion values of patients with early, untreated RA who completed the randomized controlled Coronary Artery Disease Evaluation in RA (CADERA) trial. The primary endpoint of this trial was aortic distensibility. 

In the CADERA study, 31 patients with RA and 21 healthy control participants provided analyzable perfusion data following rest and adenosine induced stress quantitative perfusion cardiovascular magnetic resonance imaging (CMR). The researchers calculated myocardial perfusion reserve values and myocardial blood flow values at rest and during stress.

Measurements of myocardial perfusion reserve (MPR) and myocardial blood flow (MBF) during stress did not significantly differ between treatment-naive patients with early RA and healthy control participants (MPR mean difference, 0.17; 95% CI, -0.39 to 0.73; P =.54; stress MBF mean difference, 0.18 mL/min/g; 95% CI, -0.05 to 0.40 mL/min/g; P =.13).

In the CADERA trial, patients with early RA received etanercept, a first-line tumor necrosis factor inhibitor (TNFi), plus methotrexate, or first-line methotrexate treat-to-target monotherapy with or without added sulphasalaine/hydroxychloroquine. Perfusion measurements did not change significantly in patients with RA after 1 year of RA-directed treatment compared with baseline values (MPR mean difference, 0.23; 95% CI, -0.16 to 0.63; P =.24; stress MBF mean difference, 0.12 mL/min/g; 95% CI, -0.21 to 0.45 mL/min/g; P =.45).

In addition, the type of RA treatment received did not significantly alter perfusion values.

Limitations of the analysis included the small sample size and that it was not powered to determine differences in perfusion.

“These early RA data differ from studies in established RA, which show reduced perfusion compared [with healthy control [participants],” the authors said. “These results could suggest possible differences in the time course of large and small vessel disease in RA, with macrovascular changes occurring before measurable myocardial microvascular disease.”

Reference

Biglands JD, Erhayiem B, Fent G, et al. Myocardial perfusion values of early, pre-treatment rheumatoid arthritis do not differ from healthy controls: a CADERA sub-study. Arthritis Rheumatol. Letter. Published online September 9, 2022. doi:10.1002/art.42341