Effects of steroid and methotrexate treatment on cardiac functions in patients with rheumatoid arthritis

Effects of steroid and methotrexate treatment on cardiac functions in patients with rheumatoid arthritis Aim: The incidence of cardiovascular involvement is increased in rheumatoid arthritis (RA) and cardiovascular involvement increases mortality in RA. The data about the influence of anti-inflammatory therapy on cardiac functions in this patient group are limited. In this study, we aimed to investigate the effects of steroid and methotrexate (Mtx) therapy on cardiac functions in newly diagnosed RA patients. Methods and Materials: Patients admitting to Rheumatology Department between January 2014-April 2016 with a de-novo RA diagnosis have been included in our study. Right and left ventricular echocardiographic, Doppler and tissue Doppler (TDI) parameters were evaluated in these patients thrice; before treatment, after 1 month of steroid treatment and after 3 months of Mtx treatment. Alterations of echocardiography and Doppler parameters were evaluated with one-way ANOVA test. A p value less than 0.05 was considered statistically significant. Results: A total of 36 patients are included in this study. Average age of the patients was 52±66 years and among these patients, 72.2 of them were women. In our study, there was a significant decrease in the values of inflammatory markers (erythrocyte sedimentation rate and c-reactive protein) after treatment (p<0,05). There was no significant change in the electrocardiographic parameters after treatment. When the echocardiographic data were compared, there was no significant change in the B and M-mode echocardiographic parameters. Left ventricular TDI mitral s wave velocity (mean of lateral s-wave and septal s wave velocities) was significantly increased (p<0,05) with treatment. Tissue Doppler tricuspid a wave was significant decreased while tricuspid E/e' ratio and tricuspid tissue doppler e' /a' ratio were significantly increased (p<0,05). Significant changes were especially noticeable after methotrexate therapy. Discussion: In this study, we observed a significant improvement in TDI parameters resembling left ventricular systolic and right ventricular diastolic functions after steroid and Mtx therapy in patients with rheumatoid arthritis. Studies performed in larger patient population with longer follow-up periods are required for more precise results. Key Words: Rheumatoid arthritis, Tissue Doppler, mitral s wave, Steroid, Methotrexate, Diastolic dysfunction