The Heart in Rheumatoid Arthritis (Rheumatoid Disease)

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Abstract
The autopsy incidence of heart disease in rheumatoid patients was significantly higher than in the control group. Hypertension and hypertensive heart disease was significantly less frequent in rheumatoid patients. Atherosclerotic heart disease and myocardial infarction, and also rheumatic heart disease were encountered with similar frequency in rheumatoid and control patients. Non-rheumatic calcific aortic stenosis and valvular sclerosis were significantly more frequent in rheumatoid patients. Cardiac lesions, dissimilar to those of rheumatic heart disease, which could not be correlated with intercurrent illness or therapy, were found in 34 rheumatoid patients. These included granu-lomata in 2; pericarditis in 18; myocarditis in 12; arteritis in 13; chronic endocarditis in 4 and valvular fibrosis in 15 patients. The overall incidence as well as the incidence of the individual lesions was sig-nigicantly more frequent than in the control group. The nature of these lesions was defined, and it was concluded that they were protean manifestations of the rheumatoid process. Lesions which were clinically manifest were illustrated by representative case reports. The post-mortem incidence of these lesions was greater than the incidence of clinical manifestations attributable to them. Nevertheless, in 17 rheumatoid patients with clinical cardiac disease, the only cardiac lesions at autopsy were those of rheumatoid disease, and 8 of these patients died of their disease. These data demonstrate that "rheumatoid heart disease" is not merely a pathological curiosity.