Heart involvement in rheumatoid arthritis: systematic review and meta-analysis.
OBJECTIVE
The aim of our study was to conduct a systematic review with meta-analysis of the current case-control studies about the valvular and pericardial involvement in patients with Rheumatoid Arthritis (RA), asymptomatic for cardiovascular diseases.


METHODS
Case-control studies were identified by searching PubMed (1975-2010) and the Cochrane Central Register of Controlled Trials (CENTRAL) (1975-2010). Participants were adult patients with RA asymptomatic for cardiovascular diseases, and the outcome measure was the presence of cardiac involvement.


RESULTS
Quantitative synthesis included 10 relevant studies out of 2326 bibliographic citations that had been found. RA resulted significantly associated to pericardial effusion (OR 10.7; 95% CI 5.0-23.0), valvular nodules (OR 12.5; 95% CI 2.8-55.4), tricuspidal valve insufficiency (OR 5.3; 95% CI 2.4-11.6), aortic valve stenosis (OR 5.2; 95% CI 1.1-24.1), mitral valve insufficiency (OR 3.4; 95% CI 1.7-6.7), aortic valve insufficiency (OR 1.7; 95% CI 1.0-2.7), combined valvular alterations (OR 4.3; 95% CI 2.3-8.0), mitral valve thickening and/or calcification (OR 5.0; 95% CI 2.0-12.7), aortic valve thickening and/or calcification (OR 4.4; 95% CI 1.1-17.4), valvular thickening and/or calcification (OR 4.8; 95% CI 2.2-10.5), and mitral valve prolapse (OR 2.2; 95% CI 1.2-4.0).


CONCLUSIONS
Our systematic review pointed out the strength and the grade of both pericardial and cardiac valvular involvement in RA patients. Our findings underscore the importance of an echocardiographic assessment at least in clinical research when RA patients are involved. Moreover, further research is needed to understand the possible relationship of our findings and the increased cardiovascular mortality.
Centre of Research for Effectiveness and Appropriateness in Medicine, Biomedical Department of Internal Medicine and Subspecialties, University of Palermo, Palermo, Italy; National Relevance Hospital Trust, Unit of Internal Medicine II, Outpatient Rheumatology Clinic, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Italy. s.corrao@tiscali.it
Salvatore
S
Corrao
Silvia
S
Messina
Giovanni
G
Pistone
Luigi
L
Calvo
Rosario
R
Scaglione
Giuseppe
G
Licata
D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D016022:Case-Control Studies; D004452:Echocardiography / Q000379:methods; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans