The Heart in Rheumatoid Arthritis

Recent reports suggesting the presence of cardiac lesions at autopsy in a high proportion of patients with rheumatoid arthritis appear to be in conflict with clinical experience.In view of the scarcity of comprehensive clinical, and the absence of radiological studies of the heart in rheumatoid arthritis, and also of the contradiction between clinical and pathological findings, there appears to be a need of further clinical and radiological material.The incidence of heart disease at autopsy in patients suffering from what is variously called nodular rheumatism, chronic rheumatism, and genuine arthritis deformans is, in earlier studies, given as between 30 to 50 per cent (Charcot, 1881; Kast, 1901; Grzimek, 1932; Klinge, 1933), the heart disease being more frequent in secondary than in primary chronic rheumatism.Changing conceptions of the atiology and classification of rheumatic diseases in more recent years are an obstacle to the direct evaluation of these findings.More recently cardiac lesions " indistinguishable from those of rheumatic fever" were described in 56 per cent of 24 patients with rheumatoid arthritis at necropsy by Baggenstoss and Rosenberg (1941 a, b), in 22 per cent of 23 patients by Bayles (1943), and in 66 per cent of 38 patients by Young and Schwedel (1944).In a clinical study Dawson (1933) found 7 cases of manifest rheumatic heart disease in 100 patients suffering from rheumatoid arthritis.Colver (1937) in 69 children with Still's disease detected carditis during life in only 1; of 4 studied at autopsy none had carditis.Hench and Rosenberg making a study of all their arthritic patients on a given date (1941) found none with clinical or electrocardiographic evidence of carditis.The incidence of clinically manifest rheumatic heart disease in a series of rheumatoid arthritis patients, examined by Bayles and McGinn (1943) was 5 per cent.Young and Schwedel's series (1944) occupies a unique place here, since the diagnosis of rheumatic heart disease was made during life in 18 of 32 patients with rheumatoid arthritis: this, together with the high number of positive cardiographic findings, suggests selective accumulation of patients with heart disease.Elman (1944) in 100 patients with rheumatoid arthritis found 8 with " rheumatic carditis," 5 of whom gave no history of rheumatic fever; he also observed 22 patients in whom rheu- matic carditis coexisted with rheumatoid arthritis.Rogen (1947) found only one patient with mitral disease in a group of 33 with rheumatoid arthritis.