Background/Purpose: Rheumatoid arthritis (RA) is chronic, systemic, inflammatory, multifactorial disease that mainly affects synovial joints. RA-patients have an increased risk of cardiovascular (CV) morbidity and mortality, being atherosclerotic CV disease the leading cause of death. Valvular heart disease (VHD) associated with RA has not been well characterized and its clinical predictors are undefined. Prevalence of VHD varies greatly in the published reports. Data in Mexican mestizo patients with RA is scarce.

Methods: A case-control study with 56 RA-patients aged 40 to 75 years that fulfilled the 2010 ACR/EULAR criteria and 28 matching control were included. Exclusion criteria included prior atherosclerotic cardiovascular disease and overlap syndromes. Patients were matched using age and sex. A standard transthoracic echocardiogram was performed according to the American Society of Echocardiography guidelines in our echocardiography lab using a 5 MHz linear transducer with a Vivid 9 (GE Healthcare, WI, USA), analyzing data in EchoPAC (GE Healthcare, WI, USA). Valvular regurgitation was classified as mild, moderate or severe according to the European Association of Echocardiography and American Society of Echocardiography recommendations.

Results: Clinical and demographic characteristics of both groups are shown in Table 1. Mean DAS28-CPR was 3.29 ± 1.56. As shown in table 2, VHD was reported in 45 (80.4%) RA-patients and 13 (46.4%) individuals in the control group (p < 0.003). Statistical difference was found in mitral and tricuspid regurgitation (p < 0.001 and p < 0.003, respectively) in RA-patients when compared with the control group. In the RA group, 5 (8.9%) showed mild aortic regurgitation; 28 had mild and 1 had moderate (50% and 1.8%, respectively) mitral regurgitation; 8 (14.3%) showed mild pulmonary regurgitation; 39 had mild and 4 had moderate (69.6% and 7.1%, respectively) tricuspid regurgitation. In the control group, 1 (3.6%) showed mild aortic regurgitation; 3 (10.7%) had mild mitral regurgitation; 1 (3.6%) showed mild pulmonary regurgitation; 12 (42.9%) had mild tricuspid regurgitation. 

Conclusion: In our cohort, VHD was present in 80.4% of the RA-patients, with the tricuspid valve being the most affected (76.8%). Statistical difference was found between the RA and the control groups when comparing mitral and tricuspid valve. Prospective studies are needed to evaluate the role in morbidity and mortality of VHD in RA-patients.