Arrhythmias in Rheumatoid Arthritis: A Call for a Multidisciplinary Team

Background: Rheumatoid arthritis is the most common systemic inflammatory disease, manifesting mainly in the synovial tissue of small and large joints, but it can involve consequential extra-articular complications. Throughout the progression of this disease, all cardiac structures, including the conducting system, myocardium, endocardium, coronary arteries, and valves, may be affected, resulting in a higher incidence of cardiac arrhythmias. Methods: We performed a narrative review of the most recent studies that emphasise the epidemiology, pathophysiology, diagnosis and management of arrhythmias found in patients with rheumatoid arthritis. Additionally, the effects of disease-modifying antirheumatic drugs (DMARDs) as conventional synthetic DMARDs (csDMARDs), biologic DMARDs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs), on cardiac electrophysiology were analysed. Results: The literature has revealed that cardiac immune cells may influence arrhythmogenesis through non-canonical and inflammatory mechanisms by modifying myocardial tissue architecture or by interacting with cardiomyocytes, potentially altering their electrical function. Conclusion: This review emphasises the essential role of a multidisciplinary approach involving, at least, rheumatologists and cardiologists in the screening and management of arrhythmias.