CASE STUDY - Reversing myocardial microvascular disease in a patient with RA

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Rheumatol. 2005 Apr;32(4):754-6.

Reversing myocardial microvascular disease in a patient with rheumatoid

arthritis.

Raza K, Kitas GD.

MRC Centre for Immune Regulation, Division of Immunity and Infection,

University of Birmingham, Birmingham, UK.

Rheumatoid arthritis (RA) is associated with increased cardiovascular

mortality. This is regarded as being due to accelerated coronary

atherosclerosis. We describe a 62-year-old man with seropositive erosive RA

and extraarticular manifestations but no history of cardiovascular disease.

Noninvasive assessment of myocardial blood flow by adenosine stressed

thallium scanning showed reversible ischemia and diffusely poor myocardial

perfusion. Repeat assessment after intensive immunosuppression for

rheumatoid vasculitis revealed resolution of the ischemic changes and

generally increased myocardial perfusion. Coronary angiography revealed no

significant atheroma, suggesting that myocardial microvascular disease was

responsible for the ischemia. This may be an important determinant of

cardiovascular outcome in RA, and this case indicated that it can be

reversed with immunosuppression.

PMID: 15801038

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Mayo Clinic in Rochester

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