Ventricular dysfunction and RA have a proinflammatory chronic state, with overactivity of cytokines as TNF-α widely accepted by its participation in ventricular dysfunction, inducing apoptosis in cardiomyocytes and negative ventricular inotropic effect, myocardial fibrosis, and ventricular remodeling [18, 19]. Here, TNF is linked to Myocardial fibrosis.