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Systemic and endothelial inflammation contribute to collagen deposition, interstitial fibrosis and therefore atrial and ventricular remodelling as well as vascular stiffening [9, 10]

Key points Methotrexate polyglutamates inhibit aminoimidazole-4-carboxamide ribonucleotide (AICAR) transformylase (ATIC), leading to intracellular accumulation of AICAR and increased adenosine release

As the disease progresses, these fibrotic regions expand, increasing tissue stiffness and impairing normal cardiac contraction

Steed H, Walsh S, Reynolds N

Instead of alcohol, try drinking more water or beverages that are low in sugar

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