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Brunner S, Covtun O, Moccetti F, Loretz L, Bossard M, Attinger‐Toller A, Cuculi F, Wolfrum M, Kurmann R, Toggweiler S. Long-Term Outcomes After Transcatheter Aortic Valve Implantation in Patients With Chronic Inflammatory Disease. J Am Heart Assoc 2024; 13:e032250. [PMID: 38390801 PMCID: PMC10944066 DOI: 10.1161/jaha.123.032250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Chronic inflammatory disease (CID) accelerates atherosclerosis and the development of aortic stenosis. Data on long-term outcomes after transcatheter aortic valve implantation (TAVI) in those patients are missing. The aim of this study was to investigate the clinical long-term outcomes of patients with and without autoimmune-related CID undergoing TAVI for the treatment of severe aortic stenosis. METHODS AND RESULTS From a prospective registry, consecutive patients with TAVI were included. Baseline clinic and imaging data (echocardiographic and computed tomography) were analyzed. Long-term (up to 5 years) clinical and echocardiographic outcomes were studied. Of 1000 consecutive patients (mean age 81±6 years, 46% female), 107 (11%) had CID; the most frequent entities included polymyalgia rheumatica (31%) and rheumatoid arthritis (28%). Patients with CID were predominantly female (60% versus 44%, P=0.002) and more often had pulmonary disorders (21% versus 13%, P=0.046) and atrial fibrillation (32% versus 20%, P=0.003). The presence of CID was associated with a higher rate of postinterventional infection (5% versus 1%, P=0.007) and further emerged as a risk factor for rehospitalization for bleeding or infection (hazard ratio, 1.93 and 1.62, respectively). Premature valve degeneration, endocarditis, and all-cause mortality were not increased among patients with CID. CONCLUSIONS This real-world analysis found that patients with CID undergoing TAVI were associated with a higher risk of postinterventional infectious complications and rehospitalization due to infection. However, valve durability and survival seem not to differ between patients with TAVI with versus without CID.
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Affiliation(s)
- Stephanie Brunner
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| | - Olga Covtun
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| | - Federico Moccetti
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| | - Lucca Loretz
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| | - Matthias Bossard
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| | | | - Florim Cuculi
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| | - Mathias Wolfrum
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| | - Reto Kurmann
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| | - Stefan Toggweiler
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
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Corrao S. Crucial safety issues on Janus kinase inhibitors in rheumatoid arthritis might be associated with the lack of LDL-cholesterol management: a reasoned literature analysis. Intern Emerg Med 2023; 18:2157-2161. [PMID: 37898967 DOI: 10.1007/s11739-023-03426-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/04/2023] [Indexed: 10/31/2023]
Abstract
This point of view explores the safety concerns of Janus kinase inhibitors (JAK-Is), used in treating rheumatoid arthritis (RA) and other rheumatologic conditions. Increasing evidence shows that JAK-Is may elevate the risk of venous thromboembolism (VTE), especially pulmonary embolism. This fact has prompted the European Medicines Agency to advise cautious use of these drugs in patients over 65, smokers, and those at risk of cardiovascular issues or cancer. The paper analyses the evidence on the association between VTE risk and RA and whether different JAK-Is pose different risks. It also probes the link between VTE, lipids, and JAK inhibition, noting that JAK-Is can alter HDL and LDL levels. On the other hand, some evidence indicates that tighter LDL-cholesterol control could mitigate VTE risk, particularly pulmonary embolism. Moreover, data from trials show little attention to treating this main cardiovascular and VTE risk factor in rheumatological patients. Although the lipid paradox theory emphasizes the U-shaped relationship between LDL cholesterol and cardiovascular risk in patients with RA, uncontrolled levels of clinically relevant LDL cholesterol remain closely linked to cardiovascular and VTE risk. In conclusion, high-potency statins could help to manage the increased cardiovascular and VTE risk concomitant to JAK-Is treatment in rheumatologic patients without depriving them of the best therapeutic choice and, in addition, reducing the inherent risk associated with the disease.
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Affiliation(s)
- Salvatore Corrao
- Department of Internal Medicine, Rheumatology Outpatient Clinic, National Relevance and High Specialization Hospital Trust ARNAS "Civico, Di Cristina, Benfratelli", Piazza Nicola Leotta 4, 90127, Palermo, Italy.
- PROMISE (Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica Di Eccellenza "G.D'Alessandro") Department, University of Palermo, Palermo, Italy.
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3
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Basile EJ, Thompson I, Rafa O, Hanna ME, Sareen NJ. Hemorrhagic Pericardial Effusion as the Presenting Symptom of Newly Diagnosed Rheumatoid Arthritis. Cureus 2022; 14:e31123. [DOI: 10.7759/cureus.31123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 11/08/2022] Open
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Long-Term Outcomes of Surgical Aortic Valve Replacement in Patients with Rheumatoid Arthritis. J Clin Med 2021; 10:jcm10112492. [PMID: 34199991 PMCID: PMC8200235 DOI: 10.3390/jcm10112492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Patients with rheumatoid arthritis (RA) have increased risk of developing cardiovascular disease and events. Little is, however, known about the influence of RA to the outcomes after surgical aortic valve replacement (SAVR). Methods: In a retrospective, nationwide, multicenter cohort study, RA patients (n = 109) were compared to patients without RA (n = 1090) treated with isolated SAVR for aortic valve stenosis. Propensity score-matching adjustment for baseline features was used to study the outcome differences in a median follow-up of 5.6 years. Results: Patients with RA had higher all-cause mortality (HR 1.76; CI 1.21–2.57; p = 0.003), higher incidence of major adverse cardiovascular events (HR 1.63; CI 1.06–2.49; p = 0.025), and they needed more often coronary artery revascularization for coronary artery disease (HR 3.96; CI 1.21–12.90; p = 0.027) in long-term follow-up after SAVR. As well, cardiovascular mortality rate was higher in patients with RA (35.7% vs. 23.4%, p = 0.023). There was no difference in 30-day mortality (2.8% vs. 1.8%, p = 0.518) or in the need for aortic valve reoperations (3.7% vs. 4.0%, p = 0.532). Conclusions: Patients with rheumatoid arthritis had impaired long-term results and increased cardiovascular mortality after SAVR for aortic valve stenosis. Special attention is needed to improve outcomes of aortic valve stenosis patients with RA after SAVR.
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Kumar P, Kalpana F, Khamuani MK, Lohana S, Dembra S, Jahangir M, Anees F, Kumar B. Frequency of Cardiovascular Manifestation in Patients With Rheumatoid Arthritis. Cureus 2021; 13:e14631. [PMID: 34046269 PMCID: PMC8140648 DOI: 10.7759/cureus.14631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic autoimmune disease. The increased inflammatory burden in RA may result in atherosclerosis, myocardial infarction (MI), and subsequent mortality. In this study, we will determine the frequency of cardiovascular manifestation in RA patients through history, laboratory workup, and echocardiography. Methods This cross-sectional study was conducted in the rheumatology unit of a tertiary care hospital in Pakistan. Three hundred and twenty-two (n=322) participants with a previously confirmed diagnosis of RA were enrolled in this study via consecutive convenient non-probability sampling. Results Cardiovascular manifestations were present in 188 (58.3%) participants. More participants had positive rheumatoid factor (82.9% vs. 32.8%; p-value: < 0.0001) in RA patients with cardiovascular manifestation compared to RA patients without cardiovascular manifestation. Patients with cardiovascular manifestations have a significantly higher C-reactive protein (CRP; 10.21 ± 2.81 mg/L vs. 8.17± 2.01 mg/L; p value: < 0.0001) and erythrocyte sedimentation rate (ESR; 16.2 ± 3.14 mg/L vs. 15.1 ± 2.99 mg/L; p value: 0.0017). Conclusion In this study, patients with a cardiovascular manifestation had a higher frequency of patients with rheumatoid factor, higher mean values of CRP and ESR. The early diagnosis and management of cardiac manifestations would aid in controlling the severity of the disease and the overall mortality.
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Affiliation(s)
- Pardeep Kumar
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Fnu Kalpana
- Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, PAK
| | | | - Sameer Lohana
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Suman Dembra
- Medicine, Peoples University of Medical and Health Sciences for Women, Nawabshah, PAK
| | - Maha Jahangir
- Anesthesiology, Dow University of Health Sciences, Karachi, PAK
| | - Faryal Anees
- Obstetrics and Gynecology, Agha Khan University Hospital, Karachi, PAK.,Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Besham Kumar
- Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Conforti A, Di Cola I, Pavlych V, Ruscitti P, Berardicurti O, Ursini F, Giacomelli R, Cipriani P. Beyond the joints, the extra-articular manifestations in rheumatoid arthritis. Autoimmun Rev 2020; 20:102735. [PMID: 33346115 DOI: 10.1016/j.autrev.2020.102735] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/18/2020] [Indexed: 12/24/2022]
Abstract
Rheumatoid arthritis (RA) is an inflammatory disease typically affecting the joints, but the systemic inflammatory process may involve other tissues and organs. Many extra-articular manifestations are recognized, which are related to worse long outcomes. Rheumatoid nodules are the most common extra-articular feature, found in about 30% of patients. Secondary Sjögren's syndrome and pulmonary manifestations are observed in almost 10% of patients, also in the early disease. Active RA with high disease activity has been associated with an increased risk of such features. Male gender, smoking habit, severe joint disease, worse function, high pro-inflammatory markers levels, high titer of rheumatoid factor, and HLA-related shared epitope have been reported as clinical predictors of occurrence of these rheumatoid complications. In addition, there is a little evidence deriving from randomized controlled trials in this field, thus the therapeutic strategy is mainly empiric and based on small case series and retrospective studies. However, considering that these extra-articular manifestations are usually related to the more active and severe RA, an aggressive therapeutic strategy is usually employed in view of the poor outcomes of these patients. The extra-articular features of RA remain, despite the improvement of joint damage, a major diagnostic and therapeutic challenge, since these are associated with a poor prognosis and need to be early recognized and promptly managed.
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Affiliation(s)
- Alessandro Conforti
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ilenia Di Cola
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Viktoriya Pavlych
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Piero Ruscitti
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Onorina Berardicurti
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Ursini
- IRRCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Roberto Giacomelli
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paola Cipriani
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Elbadawi A, Ahmed HMA, Mahmoud K, Mohamed AH, Barssoum K, Perez C, Mahmoud A, Ogunbayo GO, Omer MA, Jneid H, Chatterjee A. Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Rheumatoid Arthritis (from the Nationwide Inpatient Database). Am J Cardiol 2019; 124:1099-1105. [PMID: 31378321 DOI: 10.1016/j.amjcard.2019.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 11/29/2022]
Abstract
Little is known on the outcomes of surgical aortic valve replacement (SAVR) versus transcatheter aortic valve implantation (TAVI) in patients with rheumatoid arthritis (RA). We queried the Nationwide Inpatient Sample Database (2012 to 2016). We performed a propensity-score-matched analysis based on 25 clinical and hospital variables to compare patients with RA who underwent SAVR versus TAVI. Our primary outcome was in-hospital mortality. Our final analysis included 5,640 hospitalizations with RA who underwent isolated AVR; of whom, 2,465 (43.7%) underwent TAVI. There was an increasing trend in TAVI procedures during the study years (ptrend= 0.001). There was a trend toward reduced in-hospital mortality among TAVI compared with SAVR but did not reach statistical significance (0.8% vs 1.6%, odds ratio = 0.50; 95% confidence interval 0.23 to 1.06, p = 0.097). TAVI was associated with lower rates of postoperative bleeding (28.7% vs 43.9%, p <0.001), blood transfusion (12.3% vs 40.2%, p <0.001), acute kidney injury (9.8% vs 16.0%, p <0.001), cardiac tamponade (0.0% vs 1.6%, p <0.001), and discharges to skilled nursing facility (SNF) (20.1% vs 42.2%, p <0.001). However, TAVI was associated with a higher rate of complete heart block (14.3% vs 6.1%, p <0.001) and pacemaker implantations (14.8% vs 5.7%, p <0.001). There were no differences between both groups in cardiogenic shock, acute stroke, acute myocardial infarction, and vascular complications. In conclusion, real-word data showed no significant difference in in-hospital mortality between TAVI and SAVR in patients with RA. TAVI was associated with lower rates of acute kidney injury and bleeding complications at the expense of higher incidence of pacemaker implantations.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas.
| | - Hamdy M A Ahmed
- Division of Rheumatology, University of Alabama, Birmingham, Alabama
| | - Karim Mahmoud
- Department of Internal Medicine, Houston Medical Center, Warner Robbins, Georgia
| | - Ahmed H Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Kirolos Barssoum
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Christopher Perez
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Ahmad Mahmoud
- Department of Internal Medicine, University of Florida, Gainesville, Florida
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Mohamed A Omer
- Department of Cardiovascular Medicine, University of Missouri Kansas City, Kansas City, Missouri
| | - Hani Jneid
- Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas
| | - Arka Chatterjee
- Division of Cardiology, Division of Cardiovascular Disease, University of Alabama, Birmingham, Alabama
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8
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Dodo-Siddo MN, Diao M, Ndiaye MB, Ndongo S, Kane A, Mbaye A, Bodian M, Sarr SA, Sarr M, Ba S, Diop TM. [Study of echocardiographic parameters of rheumatoid arthritis black African without clinically evident cardiovascular manifestations: A cross-sectional study of 73 cases in Senegal]. Ann Cardiol Angeiol (Paris) 2016; 65:71-76. [PMID: 25702242 DOI: 10.1016/j.ancard.2015.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 01/20/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Research of cardiac involvement in patients with rheumatoid arthritis can prevent complications and place in a logical secondary prevention. The objective of this study was to investigate the echocardiographic parameters in a population of Senegalese patients with rheumatoid arthritis without clinically evident cardiovascular manifestations. PATIENTS AND METHOD We conducted a descriptive cross-sectional study, which included prospectively from outpatients in the internal medicine department of university hospital center Aristide Le Dantec in Dakar, Senegal, with a diagnosis of rheumatoid arthritis without clinically evident cardiovascular disease. It focused on a sample of 73 patients of both sexes aged at least 18 years. Following clinical examination, we conducted laboratory tests (CRP, fibrinogen, ESR, rheumatoid factors: Latex and Waaler-Rose, anti-CCP, antinuclear factors and anti-ENA antibodies), ECG, echocardiography standard. Data were analyzed using a descriptive study of the different variables with the calculation of proportions for categorical variables, and the positional parameters and dispersion for quantitative variables. RESULTS A total of 73 patients with rheumatoid arthritis without obvious cardiac events and meeting the criteria of definition of the ACR 1987 were included in the study. The mean age was 44.17±14.43 years with extremes of 18 and 75 years. The mean duration of RA was 5.93±4.78 years. The concept of family inflammatory arthritis was reported in 35.60% of cases and almost one in six patients had at least a factor of cardiovascular risk (16.96%). The abnormalities found in Doppler echocardiography were dominated by diastolic LV dysfunction (42.46%), increased left ventricular mass in 35.61%. Valvular leaks of variable grades were highlighted regarding all orifices but were rarely significant. CONCLUSION The realization of echocardiography in patients with rheumatoid arthritis without clinically evident cardiovascular manifestations helps to highlight cardiovascular abnormalities related to the natural course of the disease.
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Affiliation(s)
- M N Dodo-Siddo
- Service de cardiologie, hôpital Aristide Le Dantec, Dakar, Sénégal.
| | - M Diao
- Service de cardiologie, hôpital Aristide Le Dantec, Dakar, Sénégal
| | - M B Ndiaye
- Service de cardiologie, hôpital Aristide Le Dantec, Dakar, Sénégal
| | - S Ndongo
- Service de médecine interne, hôpital Aristide Le Dantec, Dakar, Sénégal
| | - A Kane
- Service de cardiologie, hôpital Aristide Le Dantec, Dakar, Sénégal
| | - A Mbaye
- Service de cardiologie, hôpital général de Grand-Yoff, Dakar, Sénégal
| | - M Bodian
- Service de cardiologie, hôpital Aristide Le Dantec, Dakar, Sénégal
| | - S A Sarr
- Service de cardiologie, hôpital Aristide Le Dantec, Dakar, Sénégal
| | - M Sarr
- Service de cardiologie, hôpital Aristide Le Dantec, Dakar, Sénégal
| | - S Ba
- Service de cardiologie, hôpital Aristide Le Dantec, Dakar, Sénégal
| | - T M Diop
- Service de médecine interne, hôpital Aristide Le Dantec, Dakar, Sénégal
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Al-Ani M, Weber M, Winchester D, Kosboth M. Pericardial mass in a patient with rheumatoid arthritis. BMJ Case Rep 2015; 2015:bcr-2015-209861. [PMID: 26055762 DOI: 10.1136/bcr-2015-209861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 65-year-old man presented with long-standing rheumatoid arthritis (RA), severe fatigue and mild arthritis of metacarpophalaneal joints. Physical examination revealed S3, II/IV decrescendo diastolic murmur and 2+ LL oedema. Anticyclic citrullinated peptide antibodies were >250 units. Echocardiogram showed an 8 cm pericardial mass with no atrial or ventricular collapse and mild to moderate aortic regurgitation. Cardiac MRI defined the mass as a heterogeneous entity attached to the right, anterior and inferior heart borders, with compression on right cardiac structures and the left ventricle. CT-guided biopsy demonstrated fibrinous material without granulomas or infection. Fatigue did not improve on immunosuppression with low-dose prednisone and leflunamide. Cardiac tamponade was confirmed by heart catheterisation and the mass was surgically excised with partial pericardiectomy. The patient had a dramatic improvement and, 4 years later, he remains asymptomatic cardiac wise. This case highlights the clinical significance of pericardial disease in RA and its response to therapy.
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Affiliation(s)
- Mohammad Al-Ani
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Michelle Weber
- Department of Pathology, Malcom Randall VAMC, NF/SGVHS, Gainesville, Florida, USA
| | - David Winchester
- Department of Internal Medicine - Division of Cardiology, University of Florida, Gainesville, Florida, USA
| | - Matthew Kosboth
- Department of Internal Medicine - Division of Rheumatology, Malcom Randall VAMC, NF/SGVHS, Gainesville, Florida, USA
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10
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Corrao S, Argano C, Pistone G, Messina S, Calvo L, Perticone F. Rheumatoid arthritis affects left ventricular mass: Systematic review and meta-analysis. Eur J Intern Med 2015; 26:259-67. [PMID: 25753937 DOI: 10.1016/j.ejim.2015.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 02/03/2015] [Accepted: 02/05/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiovascular disease represents one of the most important extra-articular causes of morbidity and mortality in patients with rheumatoid arthritis (RA). Evidences showed that several cardiac structures can be affected during the course of the disease as well as abnormalities of left ventricular diastolic filling. Contrasting data are available about left ventricular mass (LVM) involvement in patients asymptomatic for cardiovascular disease. The purpose of this systematic review and meta-analysis is to summarize the effects of RA on LVM in rheumatoid arthritis patients without cardiovascular disease. METHODS A systematic research of the current case-control studies was conducted in Medline on November 20th, 2013. Studies were included if data of measurements of LVM were reported. The pooled mean effect size estimate was calculated according to methods described by Hedges and Olkin. RESULTS Sixteen eligible studies were included in this meta-analysis. RA determines an increase of absolute and indexed LVM compared with control patients [standardized mean difference (95% CI): 0.41(0.15-0.66) and 0.47(0.32-0.62), respectively]. On the contrary, posterior wall thickness did not show a significant RA effect. Finally, a significant positive effect of RA on interventricular wall thickness was found [standardized mean difference (95% CI): 0.39 (0.07-0.71)]. CONCLUSIONS Results of this meta-analysis suggest that increased absolute and indexed LVM seem to be characteristic of RA patients with a fundamental clinical significance since they are related to an increased risk of cardiovascular morbidity and mortality. Our data suggest the use of LVM as surrogate end-point for clinical trials involving RA patients.
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Affiliation(s)
- Salvatore Corrao
- Centre of Research for Effectiveness and Appropriateness in Medicine (CREAM), Biomedical Department of Internal Medicine and Subspecialties [DiBiMIS], University of Palermo, Italy; National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Italy.
| | - Christiano Argano
- Centre of Research for Effectiveness and Appropriateness in Medicine (CREAM), Biomedical Department of Internal Medicine and Subspecialties [DiBiMIS], University of Palermo, Italy
| | - Giovanni Pistone
- National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - Silvia Messina
- Centre of Research for Effectiveness and Appropriateness in Medicine (CREAM), Biomedical Department of Internal Medicine and Subspecialties [DiBiMIS], University of Palermo, Italy
| | - Luigi Calvo
- Centre of Research for Effectiveness and Appropriateness in Medicine (CREAM), Biomedical Department of Internal Medicine and Subspecialties [DiBiMIS], University of Palermo, Italy
| | - Francesco Perticone
- Department of Experimental and Clinical Medicine, "G. Salvatore" University "Magna Graecia" of Catanzaro, Catanzaro, Italy
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Affiliation(s)
- Thomas F Lüscher
- Editor-in-Chief, Zurich Heart House, Careum Campus, Moussonstrasse 4, 8091 Zurich, Switzerland
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12
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Sen D, González-Mayda M, Brasington RD. Cardiovascular disease in rheumatoid arthritis. Rheum Dis Clin North Am 2013; 40:27-49. [PMID: 24268008 DOI: 10.1016/j.rdc.2013.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
RA can manifest in a variety of cardiac complications, including pericarditis, valvular disease, cardiomyopathy, and amyloidosis. Subclinical involvement is higher than anticipated. CVD is also prevalent in patients with RA, with onset in early disease. Several disease-specific risk factors, like seropositivity, disease activity, and medications, are implicated in the pathogenesis of CVD in RA. Cardiovascular risk assessment in RA varies from the general population. Some traditional risk factors like BMI and lipid levels apply differently to the RA population. Statins are useful in managing dyslipidemia in RA. There is good evidence to support cardiovascular risk reduction with methotrexate and TNF-I use if good disease control is achieved.
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Affiliation(s)
- Deepali Sen
- Division of Rheumatology, Department of Medicine, Campus Box 8045, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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Grimaldi A, De Gennaro L, Chiara Vermi A, Pappalardo F, Daniele Brunetti N, Di Biase M, La Canna G, Alfieri O. Cardiac valve involvement in systemic diseases: a review. Clin Cardiol 2013; 36:117-24. [PMID: 23408535 DOI: 10.1002/clc.22099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 01/13/2013] [Indexed: 11/06/2022] Open
Abstract
Increasing age and new trends of mixed populations have newly aroused interest in valvular heart disease in the developed countries still in need of new clinical insights. In the clinical setting of systemic diseases, the proper assessment of cardiovascular abnormalities may be challenging, and the characterization of valvular involvement might help to recognize the underlying disease and cardiac sequelae. Prompt identification of valvular lesions may, therefore, also be useful for differential diagnosis. This article reviews the cardiac involvement in systemic diseases from etiology and background definition to echocardiographic assessment and clinical interpretation.
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Affiliation(s)
- Antonio Grimaldi
- Cardiovascular and Thoracic Department, San Raffaele Scientific Institute and Università Vita-Salute, Milan, Italy.
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14
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Heart involvement in rheumatoid arthritis: systematic review and meta-analysis. Int J Cardiol 2012; 167:2031-8. [PMID: 22703938 DOI: 10.1016/j.ijcard.2012.05.057] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 05/07/2012] [Accepted: 05/11/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of our study was to conduct a systematic review with meta-analysis of the current case-control studies about the valvular and pericardial involvement in patients with Rheumatoid Arthritis (RA), asymptomatic for cardiovascular diseases. METHODS Case-control studies were identified by searching PubMed (1975-2010) and the Cochrane Central Register of Controlled Trials (CENTRAL) (1975-2010). Participants were adult patients with RA asymptomatic for cardiovascular diseases, and the outcome measure was the presence of cardiac involvement. RESULTS Quantitative synthesis included 10 relevant studies out of 2326 bibliographic citations that had been found. RA resulted significantly associated to pericardial effusion (OR 10.7; 95% CI 5.0-23.0), valvular nodules (OR 12.5; 95% CI 2.8-55.4), tricuspidal valve insufficiency (OR 5.3; 95% CI 2.4-11.6), aortic valve stenosis (OR 5.2; 95% CI 1.1-24.1), mitral valve insufficiency (OR 3.4; 95% CI 1.7-6.7), aortic valve insufficiency (OR 1.7; 95% CI 1.0-2.7), combined valvular alterations (OR 4.3; 95% CI 2.3-8.0), mitral valve thickening and/or calcification (OR 5.0; 95% CI 2.0-12.7), aortic valve thickening and/or calcification (OR 4.4; 95% CI 1.1-17.4), valvular thickening and/or calcification (OR 4.8; 95% CI 2.2-10.5), and mitral valve prolapse (OR 2.2; 95% CI 1.2-4.0). CONCLUSIONS Our systematic review pointed out the strength and the grade of both pericardial and cardiac valvular involvement in RA patients. Our findings underscore the importance of an echocardiographic assessment at least in clinical research when RA patients are involved. Moreover, further research is needed to understand the possible relationship of our findings and the increased cardiovascular mortality.
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Daïen CI, Fesler P. [Rheumatoid arthritis: a cardiovascular disease?]. Ann Cardiol Angeiol (Paris) 2011; 61:111-7. [PMID: 21885031 DOI: 10.1016/j.ancard.2011.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 07/24/2011] [Indexed: 11/20/2022]
Abstract
Mortality in rheumatoid arthritis (RA) is doubled when compared to the general population. This excess in mortality can be explained in half of cases by cardiovascular (CV) events. The risk of myocardial infarction is increased by about 60% in RA. Mortality secondary to cerebrovascular stroke is increased by 50% even if the incidence of stroke is not increased. Indeed, the risk of fatal CV events is increased in RA when compared to the general population. The increased CV risk cannot be explained only by traditional CV risk factors, even if smoking and changes in lipid profile may be implied. It is mainly related to the chronic inflammatory condition that causes many metabolic disturbances. Other parameters such as treatments used in RA also play a role. Thus, it is essential for proper management of RA patients to be aware of this risk and to treat any modifiable CV risk factors.
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Affiliation(s)
- C I Daïen
- Service d'immuno-rhumatologie, CHU Lapeyronie, Montpellier, France
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Marasovic-Krstulovic D, Martinovic-Kaliterna D, Fabijanic D, Morovic-Vergles J. Are the anti-cyclic citrullinated peptide antibodies independent predictors of myocardial involvement in patients with active rheumatoid arthritis? Rheumatology (Oxford) 2011; 50:1505-12. [DOI: 10.1093/rheumatology/ker121] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Association Between Acute Corneal Hydrops in Patients With Keratoconus and Mitral Valve Prolapse. Cornea 2011; 30:154-7. [DOI: 10.1097/ico.0b013e3181e846a2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Goulenok TM, Meune C, Gossec L, Dougados M, Kahan A, Allanore Y. Usefulness of routine electrocardiography for heart disease screening in patients with spondyloarthropathy or rheumatoid arthritis. Joint Bone Spine 2010; 77:146-50. [PMID: 20189433 DOI: 10.1016/j.jbspin.2010.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the usefulness of routine electrocardiography for heart disease screening in patients with spondyloarthropathy (SpA) or rheumatoid arthritis (RA). METHODS We included consecutive patients with SpA or RA or with degenerative joint disease (control group) admitted over a 6-month period and free of cardiovascular events. A 12-lead electrocardiogram (ECG) was obtained and was interpreted by a cardiologist who was unaware of the diagnosis. RESULTS We included 108 patients with SpA (mean duration, 11+/-10 years), 106 with RA (mean duration, 12+/-9 years), and 74 with degenerative joint disease (controls). No patient had cardiovascular symptoms or a prior history of cardiovascular disease. The only difference in cardiovascular risk factors across the three populations was a higher prevalence of diabetes in the RA and control groups. We found no differences between the SpA or RA groups and the control group regarding the rates of the following ECG findings: premature beats, atrioventricular block (2.8% in the SpA group, 1.9% in the RA group, and 2.7% in the control group), complete or incomplete left bundle branch block (0.9%, 0.9%, and 2.7%, respectively), complete right bundle branch bloc or left bundle branch block (0.9%, 4.7%, and 4.1%, respectively); and abnormalities suggesting myocardial ischemia (10.2%, 19.8%, and 17.6%, respectively). CONCLUSION In patients with SpA or RA who have no cardiovascular symptoms or history of cardiovascular disease, a routine ECG shows no increase in the cardiac abnormalities specifically associated with these joint diseases, compared to controls with degenerative joint disease.
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Affiliation(s)
- Tiphaine Miquel Goulenok
- Services de rhumatologie A, hôpital Cochin, AP-HP, université Paris-Descartes, 27, rue du faubourg 75679 Paris cedex 14, France
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Corrao S, Scaglione R, Calvo L, Licata G. A meta-analysis of the effect size of rheumatoid arthritis on left ventricular mass: Comment on the article by Rudominer et al. ACTA ACUST UNITED AC 2009; 60:2851-2. [DOI: 10.1002/art.24795] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Sugiura T, Kumon Y, Kataoka H, Matsumura Y, Takeuchi H, Doi Y. Asymptomatic Pericardial Effusion in Patients with Rheumatoid Arthritis. Cardiology 2007; 110:87-91. [DOI: 10.1159/000110485] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Accepted: 03/17/2007] [Indexed: 11/19/2022]
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Udayakumar N, Venkatesan S, Rajendiran C. Pulmonary hypertension in rheumatoid arthritis--relation with the duration of the disease. Int J Cardiol 2007; 127:410-2. [PMID: 17689710 DOI: 10.1016/j.ijcard.2007.04.084] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2007] [Accepted: 04/12/2007] [Indexed: 10/23/2022]
Abstract
Isolated pulmonary hypertension with clinical implication is rare in rheumatoid arthritis. We sought to study the prevalence of pulmonary arterial hypertension in an unselected population of 45 patients with rheumatoid arthritis (classified according to the ARA criteria) without cardiac disease and corresponding age and sex matched controls by Doppler echocardiography. The pulmonary artery systolic pressure was higher in patients with Rheumatoid Arthritis (27.49+/-12.66 mm Hg) than in controls (20.40+/-8.88) (p=0.003). Incidence of pulmonary artery systolic pressure>30 mm Hg suggesting pulmonary hypertension was significantly higher in patients with RA (26.7% versus 4.5% in controls; p=0.03) and 20% of patients had pulmonary hypertension without lung disease or cardiac disease evident on pulmonary function testing, and echocardiogram respectively. There was also a strong correlation between the pulmonary artery pressure and the disease duration (r=0.68, p<0.0001) suggesting a subclinical involvement of the pulmonary vasculature with disease progression and may be relevant to the high incidence of cardiovascular deaths observed in patients with Rheumatoid Arthritis.
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Roldan CA, DeLong C, Qualls CR, Crawford MH. Characterization of valvular heart disease in rheumatoid arthritis by transesophageal echocardiography and clinical correlates. Am J Cardiol 2007; 100:496-502. [PMID: 17659935 DOI: 10.1016/j.amjcard.2007.03.048] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Revised: 03/01/2007] [Accepted: 03/01/2007] [Indexed: 11/28/2022]
Abstract
Valvular heart disease (VHD) associated with rheumatoid arthritis (RA) has not been well characterized and its clinical predictors are undefined. Therefore, 34 volunteers with RA with a mean age of 50 +/- 10 years underwent clinical evaluation and transesophageal echocardiography. Findings on transesophageal echocardiography were compared with those of 34 gender-matched healthy volunteers with a mean age of 42 +/- 6 years. Twenty patients (59%) had mainly (97%) left-sided VHD (valve nodules in 11, 32%; valve thickening in 18, 53%; valve regurgitation in 7, 21%; and valve stenosis in 1, 3%) compared with 5 controls (15%; [nodules in 1, 3%; thickening in 4, 12%; and regurgitation in 1, 3%; p < or =0.05 for all vs patients). Valve nodules were generally single and small (4 to 12 mm); were oval with regular borders and had homogenous echocardiographic reflectance; were typically located at the leaflets' basal or mid portions; and equally affected the aortic and mitral valves. Valve thickening was equally diffuse or localized; when localized affected any leaflet portion; was usually mild (89%); involved similarly the mitral and aortic valves (47% and 32%, respectively); and rarely (6%) involved the annulus and subvalvular apparatus. Valve regurgitation manifested as mild aortic regurgitation in 4 patients, moderate mitral regurgitation in 4 patients, and moderate tricuspid regurgitation in 1 patient. Mitral and aortic valve stenoses occurred in 1 patient (3%). No correlation was found between VHD and duration, activity, severity, pattern of onset and course, extra-articular disease, serology, or therapy of RA. In conclusion, RA-associated VHD is common, valve nodules and thickening are its distinctive features, and it is not associated with clinical variables of RA.
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Affiliation(s)
- Carlos A Roldan
- University of New Mexico School of Medicine and Veterans Affairs Medical Center, Albuquerque, New Mexico, USA.
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Itoh M, Yoshikai M, Ohnishi H, Noguchi R, Irie K. Aortic regurgitation associated with rheumatoid arthritis: a case report. Int J Cardiol 2007; 127:e78-9. [PMID: 17582524 DOI: 10.1016/j.ijcard.2007.04.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Accepted: 04/04/2007] [Indexed: 11/25/2022]
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Abstract
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown etiology affecting both articular tissues and extraarticular organs. The disease is often progressive and results in pain, stiffness, and swelling of joints culminating in significant morbidity and increased mortality. This chapter discusses the epidemiology, possible etiology, clinical manifestations, diagnostic approach and treatment options of RA.
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Affiliation(s)
- Ritu Khurana
- Section of Rheumatology, Center of Excellence for Arhritis and Rheumatology, Louisiana State University, Health Sciences Center, School of Medicine in Shreveport, 1501 Kings Highway, Shreveport, LA 71130, USA
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Anaya JM. Severe rheumatoid valvular heart disease. Clin Rheumatol 2005; 25:743-5. [PMID: 16249828 DOI: 10.1007/s10067-005-0039-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 04/14/2005] [Indexed: 10/25/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disease in which extra-articular involvement is not uncommon. Cardiac compromise may be frequent, although most often, it is clinically silent. Herein, two cases of RA-related endocarditis, one of which required valve replacement, are described. Etanercept was useful in controlling the articular and extra-articular RA compromise in both cases.
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Affiliation(s)
- Juan-Manuel Anaya
- Unidad de Biología Celular e Inmunogenética, Corporación para Investigaciones Biológicas, Universidad del Rosario, Cra. 72-A No 78-B-141, Medellín, Colombia.
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Uusimaa P, Krogerus ML, Airaksinen J, Linnaluoto M, Tervonen O, Hakala M. Aortic valve insufficiency in patients with chronic rheumatic diseases. Clin Rheumatol 2005; 25:309-13. [PMID: 16217592 DOI: 10.1007/s10067-005-0006-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2004] [Revised: 05/03/2005] [Accepted: 05/03/2005] [Indexed: 10/25/2022]
Abstract
Aortic valve lesions are often found in patients with rheumatic diseases, but their clinical significance has not been properly evaluated. In the present study, the echocardiographic files of the cardiology unit of the Oulu University Hospital were screened for a diagnosis of aortic insufficiency (AI). The aetiology of the valve disease and specific details of the rheumatic disease were evaluated in 160 patients. Twenty-eight patients (18%) had a history of rheumatic fever. Rheumatic disease was found in 14 patients (8.8%) with AI, which is significantly more than the prevalence of rheumatic diseases (1.8%) in the corresponding age group (35-100 years) in Finland. Rheumatoid arthritis or juvenile rheumatoid arthritis was found in seven patients (4.4%), whereas ankylosing spondylitis or seronegative spondylarthropathy were found in four patients (2.5%). Other rheumatic diseases included Takayasu's arteritis (two patients) and scleroderma (one patient). When 38 patients with pure AI without other possible aetiology were analysed, rheumatic disease was found in five patients (13%). Patients with rheumatic disease as a potential aetiology of AI often had symptomatic valve disease, which required surgical treatment, although great differences between different aetiologies were not found.
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Affiliation(s)
- Paavo Uusimaa
- Department of Internal Medicine, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
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COSKUN S, OZORAN K, MERMERCI B, AYDOGDU S, KELES T. Cardiac involvement in patients with rheumatoid arthritis. ACTA ACUST UNITED AC 2005. [DOI: 10.1111/j.1479-8077.2005.00118.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hagendorff A, Pfeiffer D. Echokardiographische Funktionsdiagnostik bei Patienten mit rheumatoider Arthritis und Kollagenosen. Z Rheumatol 2005; 64:239-48. [PMID: 15909084 DOI: 10.1007/s00393-005-0734-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Accepted: 03/04/2005] [Indexed: 10/25/2022]
Abstract
Cardiac manifestations were observed in patients with rheumatoid arthritis and other collagenoses. Echocardiography is a method of choice to detect pathologies in morphology and function of the heart. Pathophysiologically inflammatory alterations of the endo- as well as perimyocardium can be explained in these patients. In addition, in patients with collagenoses, the coagulation system is activated and the reactivity of the endothelium is reduced. Thus, thrombus formation at the heart valves with consecutive stenosis and/or regurgitations as well as ischemia-induced regional wall motion defects due to reduced vasodilator response of the coronary arteries can be expected. In the literature in patients with rheumatoid arthritis and other collagenoses, pericardial effusion and pulmonary hypertension are most frequently described. The echocardiographic analysis, however, is more complex due to the variability of the patient cohort. Quantification of valve defects and the analysis of wall motion and perfusion at rest and during stress is necessary to detect early changes of the diseases. The prerequisites for successful diagnostic echocardiography in these patients are the knowledge of modern echocardiographic techniques like tissue Doppler and contrast echocardiography and clinical experience with patients with rheumatoid arthritis and other collagenoses. The standardization of the echocardiographic diagnostic procedure becomes more and more important for reproducibility and comparability of the results.
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Affiliation(s)
- A Hagendorff
- Medizinische Universitätsklinik und Poliklinik, Abteilung Kardiologie/Angiologie, Johannisallee 32, 04103, Leipzig, Germany.
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Bhatia GS, Sosin MD, Grindulis KA, Davis RC, Lip GYH. Rheumatoid disease and the heart: from epidemiology to echocardiography. Expert Opin Investig Drugs 2005; 14:65-76. [PMID: 15709923 DOI: 10.1517/13543784.14.1.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Rheumatoid disease (RD) is a common chronic inflammatory condition associated with progressive joint destruction. Sufferers of RD experience reduced life expectancy, reflected in the increased standardised mortality rates reported in several studies over the last 50 years. Most studies indicate that the increased mortality affecting this population is mainly due to cardio-vascular disease. Epidemiological data have revealed an increased risk of developing ischaemic heart disease and heart failure in RD. The increased risk of ischaemic heart disease may result from traditional risk factors but data suggest that RD may confer risk independently. Although pericardial involvement, valvopathy and myocarditis are the most well-recognised cardiac manifestations of RD, and constitute a rheumatoid heart disease, these features are relatively benign. The current prevalence of rheumatoid heart disease in the era of early administration of disease-modifying therapy requires evaluation.
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Affiliation(s)
- Gurbir S Bhatia
- University Department of Medicine, City Hospital, Birmingham, B18 7QH, UK
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Colamussi P, Prandini N, Cittanti C, Feggi L, Giganti M. Scintigraphy in rheumatic diseases. Best Pract Res Clin Rheumatol 2004; 18:909-26. [PMID: 15501189 DOI: 10.1016/j.berh.2004.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this review is to summarise the clinical role of nuclear medicine in rheumatology taking into consideration the most specific diagnostic applications and other worthwhile therapeutic contributions. Traditional bone scintigraphy and recent inflammation-targeting radiopharmaceuticals, such as radiolabelled leucocytes and immunoscintigraphy, now allow us to obtain highly sensitive total-body and tomographical imaging information that can be used for the diagnosis of osteoarticular disease. The most common extra-articular manifestations of rheumatic diseases due to digestive, central nervous, respiratory and cardiovascular system involvement can be diagnosed by specific scintigraphic methods. Radiosynovectomy plays an important role in providing effective treatment for some joint diseases that are resistant to pharmacological therapy. Diagnostic and therapeutic applications of nuclear medicine show the highest efficacy in the early phase of rheumatic diseases. In more advanced stages, scintigraphical techniques play a complementary role to radiographical investigations in the assessment of prognosis and therapy efficacy.
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Affiliation(s)
- Paolo Colamussi
- Medicina Nucleare, Azienda Ospedaliera-Universitaria di Ferrara, Cso Giovecca 203 44100 Ferrara, Italy.
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Levendoglu F, Temizhan A, Ugurlu H, Ozdemir A, Yazici M. Ventricular function abnormalities in active rheumatoid arthritis: a Doppler echocardiographic study. Rheumatol Int 2004; 24:141-6. [PMID: 12819928 DOI: 10.1007/s00296-003-0342-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2002] [Accepted: 04/23/2003] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate cardiac involvement in patients with active rheumatoid arthritis (RA). METHODS Forty patients with active RA participated. All were submitted to standard Doppler echocardiography and myocardial performance index (MPI) grading. RESULTS There were left and right ventricular diastolic function abnormalities in RA patients. Left ventricular MPI was also significantly higher than in controls ( P<0.05). A relationship was found between left ventricular early diastolic (E)/atrial (A) flow velocities (E/A ratio), isovolumic relaxation time (IRT), and disease duration ( r=-0.47 and P=0.002, r=0.618 and P=0.000, respectively). CONCLUSION Diastolic function was impaired in both ventricles in patients with active RA. There was a direct relationship between some of the parameters of left ventricular diastolic function and disease duration as well. These findings suggest a subclinical myocardial involvement in RA patients.
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Affiliation(s)
- Funda Levendoglu
- Department of Physical Medicine and Rehabilitation, Meram Medical School of Selcuk University, Meram-Konya, Turkey.
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Ben Hamda K, Betbout F, Maatouk F, Gamra H, Addad F, Touzi M, Bergaoui N, Ben Farhat M. [Rheumatoid nodule and complete heart block: diagnosis by transesophageal echocardiography]. Ann Cardiol Angeiol (Paris) 2004; 53:101-4. [PMID: 15222243 DOI: 10.1016/s0003-3928(02)00120-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
We report a case of 48 years old women with a 8 years history of rheumatoid arthritis and severe articular deformation treated during the last 6 months by prednisone (5 mg daily) and chloroquine (200 mg daily), admitted in the emergency room because of syncope. The electrocardiogram showed a complete atrioventricular block. Transesophageal echocardiography was performed and revealed an hyperechogenic mass (6 x 2.5 mm) in the interventricular septum probably related to a fibrous rheumatoid nodule. This potentially explain the atrioventricular block by infiltration of the conduction pathways. A permanent double chamber pacemaker was inserted. The chloroquine, another factor of conduction disturbances was not incriminated in this case. The conduction disturbances should be systematically detected in case of severe rheumatoid arthritis. Therefore, every patient must be submitted to a transthoracic echocardiography. Transesophageal echocardiography may be helpful to detect rheumatoid nodule.
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Affiliation(s)
- K Ben Hamda
- Service de cardiologie, CHU F. Bourguiba, Monastir 5000, Tunisie.
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Riboldi P, Gerosa M, Luzzana C, Catelli L. Cardiac involvement in systemic autoimmune diseases. Clin Rev Allergy Immunol 2002; 23:247-61. [PMID: 12402411 DOI: 10.1385/criai:23:3:247] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The heart and the vascular system are frequent and characteristic targets of several systemic autoimmune diseases, in particular Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA) and Systemic Sclerosis (SSc). In this chapter we review the classic cardiac abnormalities and the more recent data about cardiovascular involvement as part of a major disease complication determining a substantial morbidity and mortality. In addition to the classic cardiac abnormalities involving the heart structures, acute and chronic ischemic heart disease and cerebrovascular accidents are threatening clinical manifestations of SLE and RA associated to an early accelerated atherosclerosis. Immune-mediated inflammation is now recognized as an important factor involved in the pathogenesis of atherosclerosis. Ongoing clinical studies are being devised to find specific risk factors associated with systemic autoimmune diseases and/or treatment regimens. Hopefully, prophylactic measures should be available within the next few years.
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Affiliation(s)
- Piersandro Riboldi
- Department of Internal Medicine, University of Milan, Allergy and Clinical Immunology Unit, IRCCS Istituto Auxologico, Via Ariosto 13, 20145, Milan, Italy.
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Guedes C, Bianchi-Fior P, Cormier B, Barthelemy B, Rat AC, Boissier MC. Cardiac manifestations of rheumatoid arthritis: a case-control transesophageal echocardiography study in 30 patients. ARTHRITIS AND RHEUMATISM 2001; 45:129-35. [PMID: 11324775 DOI: 10.1002/1529-0131(200104)45:2<129::aid-anr164>3.0.co;2-k] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Current knowledge of the cardiac manifestations of rheumatoid arthritis (RA) stems only from clinical and transthoracic echocardiography (TTE) studies. To determine the incidence and type of heart lesions in RA, we coupled TTE with transesophageal echocardiography (TEE), which is more sensitive and more accurate. METHODS Thirty unselected RA patients (26 women and 4 men aged 27 to 84 years, with a mean age of 57.8+/-15.1 years) free of known progressive heart disease underwent a chest radiograph, an electrocardiogram, laboratory tests, and TTE coupled with TEE. Results were compared with those in age- and sex-matched patients who were free of rheumatic disease and who underwent TEE to investigate a neurologic or cardiologic disorder. RESULTS Mitral regurgitation (MR) was evidenced in 24 cases (80%). Among the controls, only 11 (37%) had MR (P < 0.001). Aortic regurgitation was found in 10 cases (33%), versus 7 controls (not significant-NS). Seven cases (23%) versus only 2 controls (7%) had tricuspid valve abnormalities (NS). Pericarditis was found in 4 cases (13%) and in none of the controls. Eleven cases had evidence of cardiomyopathy (37%) and 12 (40%) had atheroma of the aorta, this last being missed by TTE in 10 patients. Echo-generating nodules were seen on a mitral valve in 2 cases and on an aortic valve in 1. We found no correlations linking cardiac lesions to clinical or laboratory features of RA. CONCLUSION Our study demonstrated that cardiac involvement, particularly of the mitral valve, is extremely common in RA patients.
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Affiliation(s)
- C Guedes
- Rheumatology Department, Bobigny-Avicenne Teaching Hospital, France
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Hussain S, Isenberg DA. Autoimmune rheumatic diseases and the heart. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 1999; 60:95-9. [PMID: 10320838 DOI: 10.12968/hosp.1999.60.2.1813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Involvement of the heart is a common finding in autoimmune rheumatic diseases. Although clinically silent changes are common, potentially life-threatening manifestations are well known but early recognition is important if appropriate therapy is to be instituted.
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Affiliation(s)
- S Hussain
- Bloomsbury Rheumatology Unit, University College London
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