American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the most common cardiac manifestation of rheumatoid arthritis?

1. Heart Failure

2. Coronary Artery Disease

3. Pericarditis

4. Myocarditis

The correct answer is: Pericarditis

The most common cardiac manifestation of rheumatoid arthritis is pericarditis. In patients with rheumatoid arthritis (RA), inflammation can extend beyond the joints and affect various organs, including the heart. Pericarditis is an inflammation of the pericardium, the fibrous sac surrounding the heart, and is a recognized complication of multiple inflammatory conditions, including RA. Studies have shown that the prevalence of pericardial disease in patients with RA is higher compared to the general population, and it can present in various ways, including chest pain and signs of cardiac tamponade in severe cases. The chronic inflammation characteristic of RA increases the risk of pericardial effusion, where fluid accumulates in the pericardial space, further complicating the condition. In contrast, while heart failure, coronary artery disease, and myocarditis can occur in patients with RA, they are less frequently observed as direct sequelae of the disease. Heart failure may occur due to cumulative cardiovascular risk factors and previous damage rather than direct inflammatory processes. Coronary artery disease in RA patients is often linked to a higher prevalence of traditional risk factors and systemic inflammation but is not the primary cardiac manifestation. Myocarditis, though it can occur, is less common compared