Congestive heart failure (CHF) is more prevalent in people with rheumatoid arthritis (RA) than in comparable people without RA. Blood levels of TNF-a, an inflammatory cytokine, are elevated in both RA and CHF in people without RA. Many studies demonstrate that TNF-a is directly toxic to the heart, causing CHF when administered to experimental animals; consequently, blocking TNF reverses CHF in these animals. However, TNF inhibitors have been shown to be ineffective, or even harmful, when administered to people with advanced CHF. Moreover, a handful of reports in people with RA have implicated TNF inhibitors in cases of new onset or worsened CHF.

In order to address these seeming contradictions, Dr. Giles will investigate the effect of one TNF inhibitor, infliximab, on heart muscle structure and function in 20 RA patients with no history of CHF using cardiac MRI before and after treatment. He anticipates that the use of TNF inhibitors prior to the development of symptomatic CHF will be associated with a slowing of the cardiotoxic effects of TNF-a encountered in active RA. This study will help clarify current controversies regarding the prescribing of this class of medications. In addition, by using this sensitive imaging technique, novel insights will be gained about the effect of TNF-a on the rheumatoid heart.