Rheumatoid arthritis (RA) is a systemic disease we treat with medications that have systemic effects. It is becoming increasingly clear that patients with RA have accelerated atherosclerosis and that RA is an independent risk factor for the development of atherosclerotic coronary artery disease1. What is less clear is whether the presence of RA and its therapies modulates the course of coronary artery disease and its complications. In this issue of The Journal Myasoedova, et al use their extensive database from the Mayo Clinic to explore heart failure in patients with RA2. The relationship between heart failure and RA is not clear-cut. Some studies suggest that heart failure may be more frequent in patients with RA3, whereas other studies suggest the opposite4. Some of these differences can be explained by the more specific questions that the investigators are asking. Moreover, most studies of this problem are observational and depend on clinical diagnoses made during the course of clinical management, like the one in this issue. Thus, the presence or absence of heart failure is not systematically examined with questionnaires or echocardiograms, for example. This can be problematic in our effort to understand heart failure in RA patients since patients and physicians may ascribe symptoms such as ankle swelling as well as functional limitations to RA that may instead be a consequence of heart failure. Interestingly, … Address correspondence to Dr. Francis; E-mail: mark.francis{at}ttuhsc.edu
