Prevalence of Pericardial Effusion and Mitral-Valve Involvement in Patients with Rheumatoid Arthritis without Cardiac Symptoms

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Abstract
A prospective echocardiographic search for cardiac abnormalities was made in one female and 15 male patients who satisfied the criteria of the American Rheumatism Association for definite or classic rheumatoid arthritis. All these patients were free of cardiac symptoms. Seven out of 16 patients (44 per cent) had evidence of posterior pericardial effusion that could not be detected on electrocardiogram and chest x-ray study. Reduced E to F slope of the anterior leaflet of the mitral valve was present in four (three of them with sero-positive nodular disease) of 16 rheumatoid arthritis patients. This diminished diastolic slope may be due to rheumatoid involvement of the mitral-valve cusps or to changes in left ventricular compliance. Both these abnormalities were common in patients with long standing arthritis. It is now possible to demonstrate clinically the high prevalence of mitral-valve and pericardial involvement in patients with rheumatoid arthritis, previously only found in post-mortem studies. (N Engl J Med 289:597–600, 1973)

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