FIGURE 8.

Graphical abstract. In the acute inflammation phase of rheumatoid arthritis, the expression and activity of peptidyl arginine deaminase 2 (PAD2) in the heart increases. This links to aggravated PAD‐dependent citrullination of proteins involved in contractile regulation, which causes reduced myofilament Ca²⁺ sensitivity (e.g. increased amount of Ca²⁺ needed to elicit 50% of maximal myofibrillar force, Ca₅₀). This reduction is counteracted by increased [Ca²⁺]_i transient amplitudes, yet it decreases the contractile reserve. A declined contractile reserve that sensitizes the heart to insults is a factor that could explain the high prevalence of heart failure amongst patients with RA and shows the importance of monitoring RA patients for the development of HF.