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García-López ZY, Jiménez-Santos M, Flores-García CA, Moreno-Vázquez A, Magaña-Serrano JA, Prevé-Castro VM, Santos-Martínez LE. Pericarditis constrictiva y arteria coronaria única: Una rara presentación. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2018; 88:62-64. [DOI: 10.1016/j.acmx.2017.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/08/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022] Open
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Abstract
PURPOSE OF REVIEW This review article aims to provide a contemporary insight into the pathophysiological mechanisms of and therapeutic targets for pericarditis, drawing distinction between autoinflammatory and autoimmune pericarditis. RECENT FINDINGS Recent research has focused on the distinction between autoinflammatory and autoimmune pericarditis. In autoinflammatory pericarditis, viruses can activate the sensor molecule of the inflammasome, which results in downstream release of cytokines, such as interleukin-1, that recruit neutrophils and macrophages to the site of injury. Conversely, in autoimmune pericarditis, a type I interferon signature predominates, and pericardial manifestations coincide with the severity of the underlying systemic autoimmune disease. In addition, autoimmune pericarditis can also develop after cardiac injury syndromes. With either type of pericarditis, imaging can help stage the inflammatory state. Prominent pericardial delayed hyperenhancement on magnetic resonance imaging suggests ongoing inflammation whereas calcium on computed tomography suggests a completed inflammatory cascade. In patients with ongoing pericarditis, treatments that converge on the inflammasome, such as colchicine and anakinra, have proved effective in recurrent autoinflammatory pericarditis, though further clinical trials with anakinra are warranted. An improved understanding of the pathophysiological mechanisms of pericarditis helps unravel effective therapeutic targets for this condition.
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Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Desk J1-5, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Serge C Harb
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Desk J1-5, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Paul C Cremer
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Desk J1-5, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Abstract
Cardiovascular disease is an important extra-articular manifestation of rheumatologic diseases leading to considerable mortality and morbidity. Echocardiography emerges as a useful non-invasive technique for the screening and evaluation of cardiac involvement in these patients. With the technological advancement in echocardiographic techniques, we have gained a greater appreciation of the prevalence and nature of the cardiac involvement in these patients, as detection of subclinical disease is increasingly feasible. This review discusses cardiac involvement in patients with rheumatoid arthritis, systemic lupus erythematosus, anti-phospholipid antibody syndrome, systemic sclerosis and ankylosing spondylitis, and the role of different echocardiographic modalities in their evaluation.
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Affiliation(s)
- Maha A Al-Mohaissen
- Department of Clinical Sciences (Cardiology), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Kwan-Leung Chan
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, ON, Canada. .,University of Ottawa Heart Institute, 40 Ruskin Street, Room H3412, Ottawa, ON, K1Y 4W7, Canada.
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Complicated Pericarditis: Understanding Risk Factors and Pathophysiology to Inform Imaging and Treatment. J Am Coll Cardiol 2017; 68:2311-2328. [PMID: 27884251 DOI: 10.1016/j.jacc.2016.07.785] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/05/2016] [Accepted: 07/12/2016] [Indexed: 01/09/2023]
Abstract
Most patients with acute pericarditis have a benign course and a good prognosis. However, a minority of patients develop complicated pericarditis, and the care of these patients is the focus of this review. Specifically, we address risk factors, multimodality imaging, pathophysiology, and novel treatments. The authors conclude that: 1) early high-dose corticosteroids, a lack of colchicine, and an elevated high-sensitivity C-reactive protein are associated with the development of complicated pericarditis; 2) in select cases, cardiovascular magnetic resonance imaging may aid in the assessment of pericardial inflammation and constriction; 3) given phenotypic similarities between recurrent idiopathic pericarditis and periodic fever syndromes, disorders of the inflammasome may contribute to relapsing attacks; and 4) therapies that target the inflammasome may lead to more durable remission and resolution. Finally, regarding future investigations, the authors discuss the potential of cardiovascular magnetic resonance to inform treatment duration and the need to compare steroid-sparing treatments to pericardiectomy.
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Barragan-Garcia O, Soto ME, Zamora KDV, Lupi-Herrera E, Espinola-Zavaleta N. Rheumatoid arthritis: A case of multivalvular heart disease. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 87:88-91. [DOI: 10.1016/j.acmx.2016.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 11/16/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022] Open
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Generali E, Folci M, Selmi C, Riboldi P. Immune-Mediated Heart Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1003:145-171. [PMID: 28667558 DOI: 10.1007/978-3-319-57613-8_8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The heart involvement in systemic autoimmune diseases represents a growing burden for patients and health systems. Cardiac function can be impaired as a consequence of systemic conditions and manifests with threatening clinical pictures or chronic myocardial damage. Direct injuries are mediated by the presence of inflammatory infiltrate which, even though unusual, is one of the most danger manifestations requiring prompt recognition and treatment. On the other hand, a not well-managed inflammatory status leads to accelerated atherosclerosis that precipitates ischemic disease. All cardiac structures may be damaged with different grades of intensity; moreover, lesions can appear simultaneously or more frequently at a short distance from each other leading to the onset of varied clinical pictures. The pathogenesis of heart damages in systemic autoimmune conditions is not yet completely understood for the great part of situations, even if several mechanisms have been investigated. The principal biochemical circuits refer to the damaging role of autoantibodies on cardiac tissues and the precipitation of immune complexes on endocardium. These events are finally responsible of inflammatory infiltration which leads to subsequent worsening of the previous damage. For these reasons, it appears of paramount importance a regular and deepened cardiovascular assessment to prevent a progressive evolution toward heart failure in patient affected by autoimmune diseases.
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Affiliation(s)
- Elena Generali
- Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Folci
- Allergy, Clinical Immunology and Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Carlo Selmi
- Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano, Milan, Italy.,BIOMETRA Department, University of Milan, Milan, Italy
| | - Piersandro Riboldi
- Allergy, Clinical Immunology and Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy.
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Bozkurt B, Colvin M, Cook J, Cooper LT, Deswal A, Fonarow GC, Francis GS, Lenihan D, Lewis EF, McNamara DM, Pahl E, Vasan RS, Ramasubbu K, Rasmusson K, Towbin JA, Yancy C. Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e579-e646. [PMID: 27832612 DOI: 10.1161/cir.0000000000000455] [Citation(s) in RCA: 449] [Impact Index Per Article: 56.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Andersen JK, Oma I, Prayson RA, Kvelstad IL, Almdahl SM, Fagerland MW, Hollan I. Inflammatory cell infiltrates in the heart of patients with coronary artery disease with and without inflammatory rheumatic disease: a biopsy study. Arthritis Res Ther 2016; 18:232. [PMID: 27729056 PMCID: PMC5059899 DOI: 10.1186/s13075-016-1136-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background The cause of premature cardiovascular disease (CVD) in inflammatory rheumatic diseases (IRDs) has not been fully elucidated. As inflammation may play a role, we wanted to compare the occurrence and extent of inflammatory cell infiltrates (ICIs), small vessel vasculitis, and the amount of adipose tissue and collagen in cardiac biopsies taken from patients with coronary artery disease with and without IRDs. Methods From among the Feiring Heart Biopsy Study subjects, we selected patients undergoing coronary artery bypass grafting from whom paraffin-embedded, formalin-fixed specimens from the right atrium were available. The sample comprised 48 patients with IRD and 40 non-IRD patients. Hematoxylin and eosin staining was used to examine the presence and location of ICIs and vasculitis, and Lendrum (Martius yellow, scarlet, and blue) staining was carried out for collagen and adipose tissue. Results Epicardial ICIs were found in 27 (56 %) patients with IRD and 24 (60 %) non-IRD patients. There were no significant differences between patients with IRD and non-IRD patients in the amount of cardiac ICIs and adipose tissue, but patients with IRD had more collagen in the myocardium than non-IRD patients. Small vessel vasculitis was not observed in any cardiac specimen. Patients with epicardial ICIs were, on average, 7 years younger than those without. Conclusions Our results do not support the notion that inflammation in cardiac peri-, epi-, and myocardium plays a more important role in CVD of patients with IRD than non-IRD patients. The increased amount of collagen in the myocardium of patients with IRD suggests differences in extracellular matrix composition and/or mass, which might play a role in cardiac remodeling, and represent targets for novel therapies against heart failure.
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Affiliation(s)
- Jacqueline K Andersen
- Department of Health, Technology and Society, Norwegian University of Science and Technology (NTNU), Teknologiveien 22, 2815, Gjøvik, Norway.
| | - Ingvild Oma
- Department of Pathology, Innlandet Hospital Trust, Lillehammer, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Richard A Prayson
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Sven Martin Almdahl
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Ivana Hollan
- Hospital for Rheumatic Diseases, Lillehammer, Norway.,Department of Research, Innlandet Hospital Trust, Brumunddal, Norway.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Şentürk T, Yılmaz N, Sargın G, Köseoğlu K, Yenisey Ç. Relationship between asymmetric dimethylarginine and endothelial dysfunction in patients with rheumatoid arthritis. Eur J Rheumatol 2016; 3:106-108. [PMID: 27733940 PMCID: PMC5058448 DOI: 10.5152/eurjrheum.2016.15096] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/15/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In rheumatoid arthritis (RA), endothelial dysfunction caused by the inflammatory process increases the risk of cardiovascular disease. Asymmetric Dimethylarginine (ADMA) leads to vascular dysfunction, whereas atherosclerosis and increased ADMA is associated with cardiovascular disease risk factors. Flow-mediated Dilation (FMD) is a radiological method to demonstrate endothelial dysfunction. In the present study, we assessed the availability of ADMA as a marker for endothelial dysfunction in RA patients. ADMA can be used as a simple and cheaper method for the determination of endothelial dysfunction. MATERIAL AND METHODS Forty patients (1 male, 39 female) diagnosed with RA according to the classification criteria and 29 healthy volunteers (2 males, 27 females) were included in this study. ADMA was studied by enzyme-linked immunosorbent assay (ELISA). Chi-square, Fisher's exact test, Mann-Whitney U test, and Spearman's correlation tests were used for analytical analysis, and p<0.05 was considered as the level of statistical significance. RESULTS In our study, ADMA levels were significantly higher in RA patients. The ADMA level was inversely correlated with FMD. Although high levels of both C-reactive protein and ADMA were detected in patients with high disease activity, there was no statistically significant difference between these parameters (p=0.18). There were statistically significant negative correlations between FMD and age and disease duration (p=0.01, p=0.01). However, there were no statistically significant correlations with erythrocyte sedimentation rate, rheumatoid factor, and disease activity score (p=0.68). In RA patients, there was a statistically significant positive correlation between disease duration and ADMA, whereas a negative correlation was found between FMD and ADMA (p<0.05). CONCLUSION Our results support the hypothesis that ADMA may be used in the assessment of endothelial dysfunction in patients with RA. It will be cost-effective when commonly used. ADMA may be used in the assessment of endothelial dysfunction in patients with RA.
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Affiliation(s)
- Taşkın Şentürk
- Department of Rheumatology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Nergiz Yılmaz
- Department of Rheumatology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Gökhan Sargın
- Department of Rheumatology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Kutsi Köseoğlu
- Department of Radiology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Çiğdem Yenisey
- Department of Biochemistry, Adnan Menderes University School of Medicine, Aydın, Turkey
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Schatz A, Trankle C, Yassen A, Chipko C, Rajab M, Abouzaki N, Abbate A. Resolution of pericardial constriction with Anakinra in a patient with effusive-constrictive pericarditis secondary to rheumatoid arthritis. Int J Cardiol 2016; 223:215-216. [PMID: 27541656 DOI: 10.1016/j.ijcard.2016.08.131] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 08/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Aaron Schatz
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Cory Trankle
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Ali Yassen
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Christopher Chipko
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Mohammed Rajab
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Nayef Abouzaki
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
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Koca B, Sahin S, Adrovic A, Barut K, Kasapcopur O. Cardiac involvement in juvenile idiopathic arthritis. Rheumatol Int 2016; 37:137-142. [PMID: 27417551 DOI: 10.1007/s00296-016-3534-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/08/2016] [Indexed: 12/22/2022]
Abstract
An insidious progression of cardiovascular (CV) involvement is generally associated with rheumatologic diseases and finally regarded as a major source of morbidity and mortality in Juvenile idiopathic arthritis (JIA) patients. JIA could involve all of the cardiac structures, including pericardium, myocardium, endocardium; coronary vessels; valves and conduction system. Development of pericarditis, myocarditis, endocarditis and ventricular dysfunction are not unexpected issues in the progress of JIA. It is essential to ensure a comprehensive follow-up with advanced and up-to-date diagnostic and therapeutic modalities for prevention of CV complications in JIA patients. Since these are all associated with an unfavorable prognosis, it is necessary to detect subclinical cardiac involvement in CV asymptomatic patients, in order to start adequate management and treatment. Furthermore, controlling chronic inflammatory state of JIA by new treatment modalities will also significantly reduce the overall morbidity and mortality related to CV diseases. In this review, we aimed to investigate CV involvement patterns in patients with JIA.
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Affiliation(s)
- Bulent Koca
- Department of Pediatric Cardiology, Elazig Training and Research Hospital, Elazig, Turkey
| | - Sezgin Sahin
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Atakoy 1. Kisim D-43/8, 34750, Istanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Atakoy 1. Kisim D-43/8, 34750, Istanbul, Turkey
| | - Kenan Barut
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Atakoy 1. Kisim D-43/8, 34750, Istanbul, Turkey
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Atakoy 1. Kisim D-43/8, 34750, Istanbul, Turkey.
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Bhattacharjee M, Balakrishnan L, Renuse S, Advani J, Goel R, Sathe G, Keshava Prasad TS, Nair B, Jois R, Shankar S, Pandey A. Synovial fluid proteome in rheumatoid arthritis. Clin Proteomics 2016; 13:12. [PMID: 27274716 PMCID: PMC4893419 DOI: 10.1186/s12014-016-9113-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/26/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic autoinflammatory disorder that affects small joints. Despite intense efforts, there are currently no definitive markers for early diagnosis of RA and for monitoring the progression of this disease, though some of the markers like anti CCP antibodies and anti vimentin antibodies are promising. We sought to catalogue the proteins present in the synovial fluid of patients with RA. It was done with the aim of identifying newer biomarkers, if any, that might prove promising in future. METHODS To enrich the low abundance proteins, we undertook two approaches-multiple affinity removal system (MARS14) to deplete some of the most abundant proteins and lectin affinity chromatography for enrichment of glycoproteins. The peptides were analyzed by LC-MS/MS on a high resolution Fourier transform mass spectrometer. RESULTS This effort was the first total profiling of the synovial fluid proteome in RA that led to identification of 956 proteins. From the list, we identified a number of functionally significant proteins including vascular cell adhesion molecule-1, S100 proteins, AXL receptor protein tyrosine kinase, macrophage colony stimulating factor (M-CSF), programmed cell death ligand 2 (PDCD1LG2), TNF receptor 2, (TNFRSF1B) and many novel proteins including hyaluronan-binding protein 2, semaphorin 4A (SEMA4D) and osteoclast stimulating factor 1. Overall, our findings illustrate the complex and dynamic nature of RA in which multiple pathways seems to be participating actively. CONCLUSIONS The use of high resolution mass spectrometry thus, enabled identification of proteins which might be critical to the progression of RA.
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Affiliation(s)
- Mitali Bhattacharjee
- />Institute of Bioinformatics, International Technology Park, Bangalore, 560066 India
- />Amrita School of Biotechnology, Amrita University, Kollam, 690525 India
| | - Lavanya Balakrishnan
- />Institute of Bioinformatics, International Technology Park, Bangalore, 560066 India
- />Department of Biotechnology, Kuvempu University, Shankaraghatta, 577451 India
| | - Santosh Renuse
- />Institute of Bioinformatics, International Technology Park, Bangalore, 560066 India
- />Amrita School of Biotechnology, Amrita University, Kollam, 690525 India
| | - Jayshree Advani
- />Institute of Bioinformatics, International Technology Park, Bangalore, 560066 India
- />Manipal University, Madhav Nagar, Manipal, 576104 India
| | - Renu Goel
- />Institute of Bioinformatics, International Technology Park, Bangalore, 560066 India
- />Department of Biotechnology, Kuvempu University, Shankaraghatta, 577451 India
| | - Gajanan Sathe
- />Institute of Bioinformatics, International Technology Park, Bangalore, 560066 India
- />Manipal University, Madhav Nagar, Manipal, 576104 India
| | - T. S. Keshava Prasad
- />Institute of Bioinformatics, International Technology Park, Bangalore, 560066 India
- />Amrita School of Biotechnology, Amrita University, Kollam, 690525 India
| | - Bipin Nair
- />Amrita School of Biotechnology, Amrita University, Kollam, 690525 India
| | - Ramesh Jois
- />Department of Rheumatology, Fortis Hospital, Bangalore, 560066 India
| | - Subramanian Shankar
- />Department of Rheumatology, Medical Division, Command Hospital (Air Force), Bangalore, 560007 India
| | - Akhilesh Pandey
- />McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, BRB 527, Baltimore, MD 21205 USA
- />Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
- />Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
- />Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
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Mitchell AJ, Alexy T, Rubinsztain L, Iqbal A, Shah A, Zafari M, Searles CD. Rheumatoid Arthritis Presenting as Acute Myopericarditis. Am J Med 2016; 129:e17-8. [PMID: 26797082 PMCID: PMC5125546 DOI: 10.1016/j.amjmed.2015.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 11/20/2022]
Affiliation(s)
- Adam J. Mitchell
- Division of Cardiology, Department of Medicine, Emory University
| | - Tamas Alexy
- Division of Cardiology, Department of Medicine, Emory University
| | - Leon Rubinsztain
- Division of Rheumatology, Department of Medicine, Emory University
| | - Ayesha Iqbal
- Division of Rheumatology, Department of Medicine, Emory University
| | - Amit Shah
- Division of Cardiology, Department of Medicine, Emory University
| | - Maziar Zafari
- Division of Cardiology, Department of Medicine, Emory University
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Schubert AC, Wendt MMN, de Sá-Nakanishi AB, Amado CAB, Peralta RM, Comar JF, Bracht A. Oxidative state and oxidative metabolism of the heart from rats with adjuvant-induced arthritis. Exp Mol Pathol 2016; 100:393-401. [PMID: 27032477 DOI: 10.1016/j.yexmp.2016.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/11/2016] [Accepted: 03/20/2016] [Indexed: 02/01/2023]
Abstract
The aim of the present work was to investigate, in a more extensive way, the oxidative state and parameters related to energy metabolism of the heart tissue of rats using the model of adjuvant-induced arthritis. The latter is a model for the human arthritic disease. Measurements were done in the total tissue homogenate, isolated mitochondria and cytosolic fraction. The adjuvant-induced arthritis caused several modifications in the oxidative state of the heart which, in general, indicate an increased oxidative stress (+80% reactive oxygen species), protein damage (+53% protein carbonyls) and lipid damage (+63% peroxidation) in the whole tissue. The distribution of these changes over the various cell compartments was frequently unequal. For example, protein carbonyls were increased in the whole tissue and in the cytosol, but not in the mitochondria. No changes in GSH content of the whole tissue were found, but it was increased in the mitochondria (+33%) and decreased in the cytosol (-19%). The activity of succinate dehydrogenase was 77% stimulated by arthritis; the activities of glutamate dehydrogenase, isocitrate dehydrogenase and cytochrome c oxidase were diminished by 31, 25 and 35.3%, respectively. In spite of these alterations, no changes in the mitochondrial respiratory activity and in the efficiency of energy transduction were found. It can be concluded that the adjuvant-induced arthritis in rats causes oxidative damage to the heart with an unequal intracellular distribution. Compared to the liver and brain the modifications caused by arthritis in the heart are less pronounced on variables such as GSH levels and protein integrity. Possibly this occurs because the antioxidant system of the heart is less impaired by arthritis than that reported for the former tissues. Even so, the modifications caused by arthritis represent an imbalanced situation that probably contributes to the cardiac symptoms of the arthritis disease.
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Affiliation(s)
| | | | | | | | | | | | - Adelar Bracht
- Department of Biochemistry, University of Maringá, 87020900 Maringá, Brazil.
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66
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Krasselt M, Baerwald C. Efficacy and safety of modified-release prednisone in patients with rheumatoid arthritis. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:1047-58. [PMID: 27022244 PMCID: PMC4789839 DOI: 10.2147/dddt.s87792] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The introduction of modified-release (MR) prednisone adds a drug with encouraging potential to the armamentarium of the rheumatologist. In particular, for patients experiencing a reduced quality of life due to prolonged morning stiffness, it is a promising therapeutic approach. Two clinical trials and one open-label observational study investigated the effectiveness of MR prednisone in reducing rheumatoid arthritis-related morning stiffness for both new and current users of corticosteroids. The efficacy and safety of MR prednisone use in rheumatoid arthritis patients are reviewed in this article. This includes pivotal trials as well as pathophysiological considerations and clinical implications.
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Affiliation(s)
- Marco Krasselt
- Rheumatology Unit, Clinic for Gastroenterology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Leipzig, Germany
| | - Christoph Baerwald
- Rheumatology Unit, Clinic for Gastroenterology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Leipzig, Germany
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Papiris SA, Manali ED, Kolilekas L, Kagouridis K, Maniati M, Filippatos G, Bouros D. Acute Respiratory Events in Connective Tissue Disorders. Respiration 2016; 91:181-201. [PMID: 26938462 DOI: 10.1159/000444535] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Subacute-acute, hyperacute, or even catastrophic and fulminant respiratory events occur in almost all classic connective tissue disorders (CTDs); they may share systemic life-threatening manifestations, may precipitously lead to respiratory failure requiring ventilatory support as well as a combination of specific therapeutic measures, and in most affected patients constitute the devastating end-of-life event. In CTDs, acute respiratory events may be related to any respiratory compartment including the airways, lung parenchyma, alveolar capillaries, lung vessels, pleura, and ventilatory muscles. Acute respiratory events may also precipitate disease-specific extrapulmonary organ involvement such as aspiration pneumonia and lead to digestive tract involvement and heart-related respiratory events. Finally, antirheumatic drug-related acute respiratory toxicity as well as lung infections related to the rheumatic disease and/or to immunosuppression complete the spectrum of acute respiratory events. Overall, in CTDs the lungs significantly contribute to morbidity and mortality, since they constitute a common site of disease involvement; a major site of infections related to the 'mater' disease; a major site of drug-related toxicity, and a common site of treatment-related infectious complications. The extreme spectrum of the abovementioned events, as well as the 'vicious' coexistence of most of the aforementioned manifestations, requires skills, specific diagnostic and therapeutic means, and most of all a multidisciplinary approach of adequately prepared and expert scientists. Avoiding lung disease might represent a major concern for future advancements in the treatment of autoimmune disorders.
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Affiliation(s)
- Spyros A Papiris
- 2nd Department of Pneumonology, x2018;Attikon' University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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The Pericardium and Its Diseases. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00015-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Zoli A, Bosello S, Comerci G, Galiano N, Forni A, Loperfido F, Ferraccioli GF. Preserved cardiorespiratory function and NT-proBNP levels before and during exercise in patients with recent onset of rheumatoid arthritis: the clinical challenge of stratifying the patient cardiovascular risks. Rheumatol Int 2015; 37:13-19. [DOI: 10.1007/s00296-015-3390-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/02/2015] [Indexed: 12/14/2022]
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Mavrogeni S, Markousis-Mavrogenis G, Kolovou G. How to approach the great mimic? Improving techniques for the diagnosis of myocarditis. Expert Rev Cardiovasc Ther 2015; 14:105-15. [PMID: 26559548 DOI: 10.1586/14779072.2016.1110486] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Myocarditis is characterized by inflammation of the myocardium, assessed by histological, immunological and immunohistochemical criteria, due to exogenous or endogenous causes. Abnormal QRS, increased troponin T and left ventricular regional or global dysfunction may be detected. Strain Doppler echocardiography can detect longitudinal segmental dysfunction of the myocardium, due to edema, which is in agreement with cardiac magnetic resonance imaging. Nuclear imaging shows a good sensitivity, but carries serious limitations. Somatostatin receptor positron emission tomography/computed tomography seems promising. Cardiac magnetic resonance imaging, using T2-weighted, early T1-weighted, delayed enhanced images and recently T2 and T1 mapping, has the best diagnostic capability. Endomyocardial biopsy has further contributed to the etiologic diagnosis of myocarditis. To conclude, cardiac magnetic resonance and endomyocardial biopsy have both significantly increased our diagnostic performance. However, further assessment by multicenter studies is needed to establish a clinically useful algorithm.
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Affiliation(s)
- Sophie Mavrogeni
- a Department of Cardiology , Onassis Cardiac Surgery Center , Athens , Greece
| | | | - Genovefa Kolovou
- a Department of Cardiology , Onassis Cardiac Surgery Center , Athens , Greece
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Schau T, Gottwald M, Arbach O, Seifert M, Schöpp M, Neuß M, Butter C, Zänker M. Increased Prevalence of Diastolic Heart Failure in Patients with Rheumatoid Arthritis Correlates with Active Disease, but Not with Treatment Type. J Rheumatol 2015; 42:2029-37. [PMID: 26373561 DOI: 10.3899/jrheum.141647] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Although heart failure (HF) is a major cause of premature mortality, there is little information regarding its prevalence and associated risk factors in patients with rheumatoid arthritis (RA). In this study, we evaluated the prevalence of HF in a community-based RA cohort. Further, we investigated the effect of RA activity and present treatment on HF rate and cardiac structure. METHODS A diagnostic workup for HF according to the European Society of Cardiology recommendations was performed in 157 patients with RA fulfilling the American College of Rheumatology/European League Against Rheumatism criteria (68% women, age 61 ± 13 yrs) from our outpatient clinic and in 77 age- and sex-matched controls. RESULTS The prevalence of HF in patients with RA (24%) was unexpectedly high and differed significantly from the control sample (6%, p = 0.001). Diastolic HF was the dominant type (23% vs 6%), and clinical symptoms alone were of low diagnostic value. Active RA (28-joint Disease Activity Score ≥ 2.6: OR 3.4, 95% CI 1.3-9.8) was an independent risk factor of HF, as well as systemic inflammation (erythrocyte sedimentation rate > 16 mm/h: OR 5.4, 95% CI 2.1-16; C-reactive protein > 10 mg/l: OR 2.6, 95% CI 0.8-8.0) and RA duration > 10 years (OR 2.6, 95% CI 1.2-5.8). HF in RA was associated with concentric hypertrophy (48% vs 17%, p < 0.001) and reduced longitudinal strain (-17.2% vs -19.7%, p < 0.001). However, the prevalence of HF was equivalent between the treatment groups [conventional synthetic disease-modifying antirheumatic drugs (DMARD) 25%, tumor necrosis factor inhibitors 22%, other biological DMARD 27%]. CONCLUSION Recognition of all diastolic HF in RA requires a complex diagnostic approach. Active rather than inactive RA places patients at a higher risk for HF, whereas influence of RA treatment on HF risk needs to be elucidated in further studies.
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Affiliation(s)
- Thomas Schau
- From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg
| | - Michael Gottwald
- From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg
| | - Olga Arbach
- From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg
| | - Martin Seifert
- From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg
| | - Maren Schöpp
- From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg
| | - Michael Neuß
- From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg
| | - Christian Butter
- From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg
| | - Michael Zänker
- From the Department of Cardiology, and Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; Rheumatic Disease Center Northern Brandenburg, Bernau; Stem Cell Facility, Charité Universitätsmedizin Berlin, Berlin, Germany.T. Schau, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Gottwald, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, Brandenburg Medical School; O. Arbach, MD, Stem Cell Facility, Charité Universitätsmedizin Berlin; M. Seifert, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Schöpp, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Neuß, MD, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; C. Butter, MD, Professor, Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School; M. Zänker, MD, Department of Internal Medicine, Nephrology and Rheumatology, Heart Center Brandenburg, and Rheumatic Disease Center Northern Brandenburg.
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Abstract
Cardiotoxicity is a broad term that refers to the negative effects of toxic substances on the heart. Cancer drugs can cause cardiotoxicity by effects on heart cells, thromboembolic events, and/or hypertension that can lead to heart failure. Rheumatoid arthritis biologics may interfere with ischemic preconditioning and cause/worsen heart failure. Long-term and heavy alcohol use can result in oxidative stress, apoptosis, and decreased contractile protein function. Cocaine use results in sympathetic nervous system stimulation of heart and smooth muscle cells and leads to cardiotoxicity and evolution of heart failure. The definition of cardiotoxicity is likely to evolve along with knowledge about detecting subclinical myocardial injury.
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Affiliation(s)
- Christopher S Lee
- School of Nursing and Knight Cardiovascular Institute, Oregon Health and Science University, Mail Code: SN-2N, 3455 SW, US Veterans Hospital Road, Portland, OR 97239-2941, USA.
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73
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Spontaneous retrotransposon insertion into TNF 3'UTR causes heart valve disease and chronic polyarthritis. Proc Natl Acad Sci U S A 2015. [PMID: 26195802 DOI: 10.1073/pnas.1508399112] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic inflammatory diseases that together affect 2-3% of the population. RA and AS predominantly involve joints, but heart disease is also a common feature in RA and AS patients. Here we have studied a new spontaneous mutation that causes severe polyarthritis in bone phenotype spontaneous mutation 1 (BPSM1) mice. In addition to joint destruction, mutant mice also develop aortic root aneurism and aorto-mitral valve disease that can be fatal depending on the genetic background. The cause of the disease is the spontaneous insertion of a retrotransposon into the 3' untranslated region (3'UTR) of the tumor necrosis factor (TNF), which triggers its strong overexpression in myeloid cells. We found that several members of a family of RNA-binding, CCCH-containing zinc-finger proteins control TNF expression through its 3'UTR, and we identified a previously unidentified regulatory element in the UTR. The disease in BPSM1 mice is independent of the adaptive immune system and does not appear to involve inflammatory cytokines other than TNF. To our knowledge, this is the first animal model showing both polyarthritis and heart disease as a direct result of TNF deregulation. These results emphasize the therapeutic potential of anti-TNF drugs for the treatment of heart valve disease and identify potential therapeutic targets to control TNF expression and inflammation.
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74
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Abstract
Autoimmune carditis is associated with many human rheumatic conditions, including rheumatic fever, systemic lupus erythematosus, and rheumatoid arthritis. The immune mechanisms that mediate the cardiovascular pathology connected to these diseases are poorly defined. Several animal models are used to recapitulate human pathophysiology in order to better characterize the immunopathogenic mechanisms driving autoimmune endocardial inflammation. These animal models point toward common mechanisms mediating autoimmune endocarditis; in particular, CD4+ T cells and pro-inflammatory macrophages play critical roles in directing the disease process. The goals of this review are to discuss the prevailing animal models of autoimmune endocarditis and their underlying immunologic mechanisms and to provide insight regarding potential therapeutic targets in humans.
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75
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Iversen MD, Scanlon L, Frits M, Shadick NA, Sharby N. Perceptions of physical activity engagement among adults with rheumatoid arthritis and rheumatologists. ACTA ACUST UNITED AC 2015; 10:67-77. [PMID: 26075028 DOI: 10.2217/ijr.15.3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM Physical activity (PA) among adults with rheumatoid arthritis (RA) is suboptimal. This study assessed PA motivations and perceptions in adults with RA and rheumatologists. METHODS Patients and rheumatologists participated in structured interviews led by a behavioral scientist. Sessions were audiotaped, transcribed and coded. RESULTS Twenty-three patients (mean age = 63 [standard deviation = 10], 96% female) and seven rheumatologists (57% male, 29% fellows) participated. Nine themes emerged: communication with the rheumatologist, environment/access, symptom management, social support, mental health, breaking inactivity cycles, integrating PA into routines, staying in control and challenge/intimidation. Highly active patients viewed PA differently than low active patients. The need to compete with RA-free individuals may impede PA. CONCLUSION Understanding how patients conceptualize PA will enable clinicians to formulate PA strategies to motivate patients.
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Affiliation(s)
- Maura D Iversen
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, 301 C RB, Boston, MA 02115, USA ; Section of Clinical Sciences, Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Boston, MA 02115, USA ; Harvard Medical School, Boston, MA, 02115, USA
| | - Lauren Scanlon
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, 301 C RB, Boston, MA 02115, USA
| | - Michelle Frits
- Section of Clinical Sciences, Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Boston, MA 02115, USA
| | - Nancy A Shadick
- Section of Clinical Sciences, Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Boston, MA 02115, USA ; Harvard Medical School, Boston, MA, 02115, USA
| | - Nancy Sharby
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, 301 C RB, Boston, MA 02115, USA
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76
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Abstract
Autoimmune rheumatic diseases can affect the cardiac vasculature, valves, myocardium, pericardium, and conduction system, leading to a plethora of cardiovascular manifestations that can remain clinically silent or lead to substantial cardiovascular morbidity and mortality. Although the high risk of cardiovascular pathology in patients with autoimmune inflammatory rheumatological diseases is not owing to atherosclerosis alone, this particular condition contributes substantially to cardiovascular morbidity and mortality-the degree of coronary atherosclerosis observed in patients with rheumatic diseases can be as accelerated, diffuse, and extensive as in patients with diabetes mellitus. The high risk of atherosclerosis is not solely attributable to traditional cardiovascular risk factors: dysfunctional immune responses, a hallmark of patients with rheumatic disorders, are thought to cause chronic tissue-destructive inflammation. Prompt recognition of cardiovascular abnormalities is needed for timely and appropriate management, and aggressive control of traditional risk factors remains imperative in patients with rheumatic diseases. Moreover, therapies directed towards inflammatory process are crucial to reduce cardiovascular disease morbidity and mortality. In this Review, we examine the multiple cardiovascular manifestations in patients with rheumatological disorders, their underlying pathophysiology, and available management strategies, with particular emphasis on the vascular aspects of the emerging field of 'cardiorheumatology'.
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77
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Chen Y, Chung HY, Zhao CT, Wong A, Zhen Z, Tsang HHL, Lau CS, Tse HF, Yiu KH. Left ventricular myocardial dysfunction and premature atherosclerosis in patients with axial spondyloarthritis. Rheumatology (Oxford) 2014; 54:292-301. [DOI: 10.1093/rheumatology/keu337] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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78
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Yoshida S, Takeuchi T, Sawaki H, Imai T, Makino S, Hanafusa T. Successful treatment with tocilizumab of pericarditis associated with rheumatoid arthritis. Mod Rheumatol 2014; 24:677-80. [DOI: 10.3109/14397595.2013.874733] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shuzo Yoshida
- Internal Medicine, Arisawa General Hospital,
Osaka, Japan
- Department of Internal Medicine (Ι), Osaka Medical College,
Osaka, Japan
| | - Tohru Takeuchi
- Department of Internal Medicine (Ι), Osaka Medical College,
Osaka, Japan
| | - Hideaki Sawaki
- Internal Medicine, Arisawa General Hospital,
Osaka, Japan
| | - Tamaki Imai
- Internal Medicine, Arisawa General Hospital,
Osaka, Japan
| | - Shigeki Makino
- Department of Internal Medicine (Ι), Osaka Medical College,
Osaka, Japan
| | - Toshiaki Hanafusa
- Department of Internal Medicine (Ι), Osaka Medical College,
Osaka, Japan
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79
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Risk factors for asymptomatic ventricular dysfunction in rheumatoid arthritis patients. ISRN CARDIOLOGY 2013; 2013:635439. [PMID: 24368945 PMCID: PMC3866864 DOI: 10.1155/2013/635439] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/08/2013] [Indexed: 11/29/2022]
Abstract
Objective. The aim of the study was to describe echocardiographic abnormalities in patients with rheumatoid arthritis, concurrent systemic comorbidities, rheumatologic clinical activity, serologic markers of rheumatoid arthritis, and inflammatory activity. Methods. In an observational, cross-sectional study, rheumatoid arthritis outpatients were included (n = 105). Conventional transthoracic echocardiographic variables were compared between patients with arthritis and non-RA controls (n = 41). For rheumatoid arthritis patients, articular activity and rheumatologic and inflammatory markers were obtained. Results. Ventricular dysfunction was found in 54.3% of the population: systolic (18.1%), diastolic (32.4%), and/or right (24.8%), with lower ejection fraction (P < 0.0001). Pulmonary hypertension was found in 46.9%. Other echocardiographic findings included increased left atrial diameter (P = 0.01), aortic diameter (P = 0.01), ventricular septum (P = 0.01), left ventricular posterior wall (P = 0.013), and right ventricular (P = 0.01) and atrial diameters compared to control subjects. Rheumatoid factor and anti-CCP antibodies levels were significantly elevated in cases with ventricular dysfunction. Angina and myocardial infarction, diabetes, and dyslipidemia were the main risk factors for ventricular dysfunction. Conclusions. Ventricular dysfunction is common in rheumatoid arthritis and associated with longer disease duration and increased serologic markers of rheumatoid arthritis. Screening for cardiac abnormalities should be considered in this kind of patients.
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80
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He Y, Wong AYS, Chan EW, Lau WCY, Man KKC, Chui CSL, Worsley AJ, Wong ICK. Efficacy and safety of tofacitinib in the treatment of rheumatoid arthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord 2013; 14:298. [PMID: 24139404 PMCID: PMC3819708 DOI: 10.1186/1471-2474-14-298] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 10/11/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Tofacitinib is a disease-modifying antirheumatic drug (DMARD) which was recently approved by US Food and Drug Administration (FDA). There are several randomised clinical trials (RCTs) that have investigated the efficacy and safety of tofacitinib in adult patients with rheumatoid arthritis (RA). A systematic review with a meta-analysis of RCTs was undertaken to determine the efficacy and safety of tofacitinib in treating patients with RA. METHODS Electronic and clinical trials register databases were searched for published RCTs of tofacitinib between 2009 and 2013. Outcomes of interest include 20% and 50% improvement in the American College of Rheumatology Scale (ACR20 and ACR50) response rates, rates of infection, the number of immunological/haematological adverse events (AEs), deranged laboratory results (hepatic, renal, haematological tests and lipoprotein level) and the incidence of drug withdrawal. RESULTS Eight RCTs (n = 3,791) were reviewed. Significantly greater ACR20 response rates were observed in patients receiving tofacitinib 5 and 10 mg bid (twice daily) versus placebo at week 12, with risk ratios (RR) of 2.20 (95% CI 1.58, 3.07) and 2.38 (95% CI 1.81, 3.14) respectively. The effect was maintained at week 24 for 5 mg bid (RR 1.94; 95% CI 1.55, 2.44) and 10 mg bid (RR 2.20; 95% CI 1.76, 2.75). The ACR50 response rate was also significantly higher for patients receiving tofacitinib 5 mg bid (RR 2.91; 95% CI 2.03, 4.16) and 10 mg bid (RR 3.32; 95% CI 2.33, 4.72) compared to placebo at week 12. Patients in the tofacitinib group had significantly lower mean neutrophil counts, higher serum creatinine, higher percentage change of LDL/HDL and a higher risk of ALT/AST > 1 ULN (upper limit of normal) versus placebo. There were no significant differences in AEs and withdrawal due to AEs compared to placebo. CONCLUSION Tofacitinib is efficacious and well tolerated in patients with MTX-resistant RA up to a period of 24 weeks. However, haematological, liver function tests and lipoproteins should be monitored. Long-term efficacy and pharmacovigilance studies are recommended.
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Affiliation(s)
- Ying He
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong
| | - Angel YS Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wallis CY Lau
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kenneth KC Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong
| | - Celine SL Chui
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong
| | - Alan J Worsley
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ian CK Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong
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81
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Joyce E, Fabre A, Mahon N. Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 2:77-83. [PMID: 24062937 DOI: 10.1177/2048872612471215] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 11/26/2012] [Indexed: 11/17/2022]
Abstract
Cardiotoxicity is a rare but serious complication of hydroxychloroquine, a 4-aminoquinoline increasingly used in the treatment of rheumatological disorders. We describe typical clinical, echocardiographic, and histological features of this rare condition according to the currently available literature, illustrated with a recent new biopsy-proven case of hydroxychloroquine cardiotoxicity in a 52-year-old female with rheumatoid arthritis. Presentation in this case was of a rapidly progressive decompensated biventricular cardiomyopathy associated with recurrent biomarker elevations, conduction system disease, and possibly neuromyotoxicity. Death occurred suddenly 2 months after diagnosis despite drug discontinuation and clinical improvement. The potential role of cardiac magnetic resonance delayed gadolinium enhancement imaging in the prognosis of this toxic cardiomyopathy is also introduced. This case-based literature review highlights that, although rare, hydroxychloroquine cardiotoxicity can be fatal, particularly if irreversible histopathological changes have occurred prior to drug discontinuation. Given this, regular screening with 12-lead electrocardiography and transthoracic echocardiography to detect conduction system disease and/or biventricular morphological or functional changes should be considered in hydroxychloroquine-treated patients in addition to recommended ophthalmological screening.
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Affiliation(s)
- Emer Joyce
- Mater Misericordiae University Hospital, Dublin, Ireland ; Leiden University Medical Center, Leiden, The Netherlands
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82
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Abstract
Rheumatoid arthritis (RA) represents an autoimmune disease affecting mostly joints, in particular small finger and toe joints. In addition RA can show extra-articular manifestations in many organs. Information on the frequency of extra-articular manifestations (EAMs) in RA varies greatly in different publications from 17.8% to 40.9% and EAMs tend to become higher with increasing duration and severity of the disease. The exact etiology and pathogenesis are still unclear but vasculitic alterations together with deposition of immune complexes can often be found histopathologically in affected organs. It must also be taken into consideration that EAMs can also be a result of the pharmaceutical therapy. The organ findings can vary greatly which is also reflected in the multitude of clinical symptoms. Possible target organs are the blood vessels, kidneys, central nervous system, cardiovascular system, the lungs, eyes, skin, nails as well as blood and the hemopoetic system. The prognosis for RA becomes progressively worse in the presence of EAMs. Regular and continuous control investigations are necessary in order to be able to diagnose EAMs early and to begin therapy. Therapy includes the administration of non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs) and especially in advanced stages cyclophosphamide or biologicals. Therapy is still very empirical due to the lack of appropriate studies.
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83
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Heart involvement in rheumatoid arthritis: multimodality imaging and the emerging role of cardiac magnetic resonance. Semin Arthritis Rheum 2013; 43:314-24. [PMID: 23786873 DOI: 10.1016/j.semarthrit.2013.05.001] [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] [Received: 12/23/2012] [Revised: 04/22/2013] [Accepted: 05/02/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Patients with rheumatoid arthritis (RA) exhibit a high risk of cardiovascular disease (CVD). CVD in RA can present in many guises, commonly detected at a subclinical level only. METHODS Modern imaging modalities that allow the noninvasive assessment of myocardial performance and are able to identify cardiac abnormalities in early asymptomatic stages may be useful tools in terms of screening, diagnostic evaluation, and risk stratification in RA. RESULTS The currently used imaging techniques are echocardiography, single-photon emission computed tomography (SPECT), and cardiac magnetic resonance (CMR). Between them, echocardiography provides information about cardiac function, valves, and perfusion; SPECT provides information about myocardial perfusion and carries a high amount of radiation; and CMR-the most promising imaging modality-evaluates myocardial function, inflammation, microvascular dysfunction, valvular disease, perfusion, and presence of scar. Depending on availability, expertise, and clinical queries, "right technique should be applied for the right patient at the right time." CONCLUSIONS In this review, we present a short overview of CVD in RA focusing on the clinical implication of multimodality imaging and mainly on the evolving role of CMR in identifying high-risk patients who could benefit from prevention strategies and early specific treatment targeting the heart. Advantages and disadvantages of each imaging technique in the evaluation of RA are discussed.
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84
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Inanir A, Yigit S, Tekcan A, Tural S, Kismali G. IL-4 and MTHFR gene polymorphism in rheumatoid arthritis and their effects. Immunol Lett 2013; 152:104-8. [PMID: 23685257 DOI: 10.1016/j.imlet.2013.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 04/13/2013] [Accepted: 05/06/2013] [Indexed: 12/30/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease that mainly affects the joints. Polymorphic variations of the cytokine genes and MTHFR gene have received attention as potential markers of susceptibility, severity, and/or protection in RA. The aim of this study was to investigate the MTHFR C677T and IL-4 70bp VNTR variation in Turkish patients with RA and evaluate if there was an association with clinical features, especially ocular involvement, in RA patients. The study included 297 persons (147 patients with RA and 150 healthy controls). Genomic DNA was isolated and genotyped using PCR assay for the MTHFR gene C677T and IL-4 gene 70bp VNTR polymorphisms. Our results show that there was statistically significant difference between the groups with respect to IL-4 genotype (p=0.01) and allele frequencies (p<0.002). There was no statistical significant difference in the genotype frequencies MTHFR gene, but allele frequencies showed statistically significant association (p=0.01). When we examined MTHFR and IL-4 genotype frequencies according to the clinical characteristics, we found that there was a difference between MTHFR genotypes and ocular involvement but it is not to a statistical significant degree (p=0.09). In the combined genotype analysis, MTHFR/IL-4 CCP2P2 combine genotype was estimated to have protective effect against RA, CTP1P2 combine genotype was found to be risk for RA. Our findings suggest that there is an association of IL-4 gene 70bp VNTR polymorphism and MTHFR C677T polymorphism with susceptibility of a person for development of RA.
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Affiliation(s)
- Ahmet Inanir
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Gaziosmanpasa University, Tokat, 60100, Turkey.
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85
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Tönnesmann E, Kandolf R, Lewalter T. Chloroquine cardiomyopathy – a review of the literature. Immunopharmacol Immunotoxicol 2013; 35:434-42. [DOI: 10.3109/08923973.2013.780078] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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86
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Owlia MB, Mirhosseini SJ, Naderi N, Mostafavi Pour Manshadi SMY, Ali-Hasan-Al-Saegh S. Rheumatological findings in candidates for valvular heart surgery. ISRN RHEUMATOLOGY 2013; 2012:927923. [PMID: 23304546 PMCID: PMC3529864 DOI: 10.5402/2012/927923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 10/03/2012] [Indexed: 11/23/2022]
Abstract
Background and Objectives. Valvular heart diseases are among the frequent causes of cardiac surgery. Some patients have a well-known rheumatic condition. Heart valves are fragile connective tissues which are vulnerable to any systemic autoimmune diseases. This study was designed to evaluate the frequency of rheumatological background in patients candidate for valvular heart surgery in Afshar Cardiovascular Center, Yazd, Iran. Methods. One hundred and twenty (120) patients candidate for valvular heart surgery were selected for this study. Careful history and physical examination were undertaken from rheumatological stand points. The most sensitive screening serologic tests were also assayed. Results. The result of this study showed that 53.3% were male and 46.6% were female with mean age of 48.18 ± 17.65 years old. 45.8% of the patients had history of nonmechanical joint disease, 14.2% had history of rheumatological conditions in their family, and 30% had history of constitutional symptoms. 29.8% had positive joint dysfunction findings in their physical examination while 25.8% had anemia of chronic disease. Positive Rheumatoid factor (RF), anticyclic citrullinated peptide (CCP, ACPA), C-reactive protein (CRP), antinuclear antibody (ANA), abnormal urine and elevated erythrocyte sedimentation rate (ESR) were 34, 2.5, 26.7, 4.2, 5, and 36.7%, respectively. Antineutrophil cytoplasmic antibody (ANCA) and antiphospholipid (APL) were positive in a few cases. Conclusion. The findings of this study show immunologic bases for most patients with valvular heart diseases candidate for surgery. Undifferentiated connective tissue diseases may play an important role in the pathophysiology of valvular damage.
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Affiliation(s)
- Mohammad Bagher Owlia
- Department of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
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87
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Yoshida S, Takeuchi T, Sawaki H, Imai T, Makino S, Hanafusa T. Successful treatment with tocilizumab of pericarditis associated with rheumatoid arthritis. Mod Rheumatol 2012. [DOI: 10.1007/s10165-012-0805-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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88
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Cardiovascular disease in rheumatoid arthritis: a systematic literature review in latin america. ARTHRITIS 2012. [PMID: 23193471 PMCID: PMC3501796 DOI: 10.1155/2012/371909] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background. Cardiovascular disease (CVD) is the major predictor of poor prognosis in rheumatoid arthritis (RA) patients. There is an increasing interest to identify "nontraditional" risk factors for this condition. Latin Americans (LA) are considered as a minority subpopulation and ethnically different due to admixture characteristics. To date, there are no systematic reviews of the literature published in LA and the Caribbean about CVD in RA patients. Methods. The systematic literature review was done by two blinded reviewers who independently assessed studies for eligibility. The search was completed through PubMed, LILACS, SciELO, and Virtual Health Library scientific databases. Results. The search retrieved 10,083 potential studies. A total of 16 articles concerning cardiovascular risk factors and measurement of any cardiovascular outcome in LA were included. The prevalence of CVD in LA patients with RA was 35.3%. Non-traditional risk factors associated to CVD in this population were HLA-DRB1 shared epitope alleles, rheumatoid factor, markers of chronic inflammation, long duration of RA, steroids, familial autoimmunity, and thrombogenic factors. Conclusions. There is limited data about CVD and RA in LA. We propose to evaluate cardiovascular risk factors comprehensively in the Latin RA patient and to generate specific public health policies in order to diminish morbi-mortality rates.
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89
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Owlia MB, Mostafavi Pour Manshadi SMY, Naderi N. Cardiac manifestations of rheumatological conditions: a narrative review. ISRN RHEUMATOLOGY 2012; 2012:463620. [PMID: 23119182 PMCID: PMC3483730 DOI: 10.5402/2012/463620] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/21/2012] [Indexed: 01/08/2023]
Abstract
Cardiovascular diseases are common in systemic rheumatologic diseases. They can be presented at the time of diagnosis or after diagnosis. The cardiac involvements can be the first presentation of rheumatologic conditions. It means that a patient with rheumatologic disease may go to a cardiologist when attacked by this disease at first. These manifestations are very different and involve different structures of the heart, and they can cause mortality and morbidity of patients with rheumatologic diseases. Cardiac involvements in these patients vary from subclinical to severe manifestations. They may need aggressive immunosuppressive therapy. The diagnosis of these conditions is very important for choosing the best treatment. Premature atherosclerosis and ischemic heart disease are increased in rheumatoid arthritis and systemic lupus erythematosus, and may be causes of mortality among them. The aggressive control of systemic inflammation in these diseases can reduce the risk of cardiovascular disease especially ischemic heart disease. Although aggressive treatment of primary rheumatologic diseases can decrease mortality rate and improve them, at this time, there are no specific guidelines and recommendations, to include aggressive control and prevention of traditional risk factors, for them.
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Affiliation(s)
- Mohammad Bagher Owlia
- Department of Medicine, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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90
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Ansari MS, Habib SK, Ahmad Siddiqui O, Ahmad Z. Subarachnoid block in a case of rheumatoid arthritis with severe pulmonary fibrosis. BMJ Case Rep 2012; 2012:bcr-2012-006294. [PMID: 23035159 DOI: 10.1136/bcr-2012-006294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Rheumatoid arthritis (RA) is the most common chronic inflammatory arthritis, of unknown aetiology and a propensity to involve almost all organ systems. The anaesthesiologists should be aware of the associated airway pathologies, pain management techniques and adverse effects of drug therapies being used to treat RA. In this respect, we describe a 60-year-old female patient who presented with a diagnosis of RA with pulmonary fibrosis, and was scheduled for orthopaedic surgery for subcapital fracture of femur which was successfully managed using intrathecal bupivacaine and midazolam.
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91
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Nakamura Y, Izumi C, Nakagawa Y, Hatta K. A case of effusive-constrictive pericarditis accompanying rheumatoid arthritis: The possibility of adverse effect of TNF-inhibitor therapy. J Cardiol Cases 2012; 7:e8-e10. [PMID: 30533107 DOI: 10.1016/j.jccase.2012.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/26/2012] [Accepted: 08/28/2012] [Indexed: 12/27/2022] Open
Abstract
A 68-year-old female, suffering from rheumatoid arthritis, was admitted to our institution for right heart failure with massive pericardial effusion. Her pericardial effusion had increased after starting infliximab, tumor necrosis factor (TNF)-inhibitor therapy, despite improvement in arthralgia. Hemodynamic findings demonstrated effusive-constrictive pericarditis. Because association between exacerbation of pericarditis and infliximab was highly suspected through her clinical course, its administration was stopped. We should pay much attention to pericardial effusion and symptoms of right heart failure after starting TNF-inhibitor therapy in patients with rheumatoid arthritis. <Learning objective: TNF-inhibitor therapy has become a treatment option for rheumatoid arthritis, however, it may cause exacerbation of extra articular manifestations such as pericarditis. We encountered a patient with rheumatoid arthritis who developed effusive-constrictive pericarditis while on TNF-inhibitor therapy. We should pay much attention to pericardial effusion and symptoms of right heart failure after starting TNF-inhibitor therapy in patients with rheumatoid arthritis.>.
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Affiliation(s)
- Yoshiaki Nakamura
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara 632-8552, Japan
| | - Chisato Izumi
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara 632-8552, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara 632-8552, Japan
| | - Kazuhiro Hatta
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara 632-8552, Japan
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92
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Invited commentary. Ann Thorac Surg 2012; 94:515. [PMID: 22818303 DOI: 10.1016/j.athoracsur.2012.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 05/31/2012] [Accepted: 06/06/2012] [Indexed: 11/21/2022]
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93
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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: 52] [Impact Index Per Article: 4.3] [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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94
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Carrion DM, Carrion AF. Cardiac tamponade as an initial manifestation of systemic lupus erythematosus. BMJ Case Rep 2012; 2012:bcr-03-2012-6126. [PMID: 22693326 DOI: 10.1136/bcr-03-2012-6126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Clinical manifestations of pericardial disease may precede other signs and symptoms associated with systemic lupus erythematosus. Although pericardial effusion is one of the most common cardiac problems in patients with systemic lupus erythematosus, haemodynamically significant effusions manifesting as cardiac tamponade are rare and require prompt diagnosis and treatment.
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95
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Kang JH, Keller JJ, Lin HC. Outcomes of nonstenting percutaneous coronary intervention in patients with rheumatoid arthritis. Am J Cardiol 2012; 109:1160-3. [PMID: 22264593 DOI: 10.1016/j.amjcard.2011.11.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 11/11/2011] [Accepted: 11/11/2011] [Indexed: 10/14/2022]
Abstract
The aim of the present study was to explore the outcomes of percutaneous coronary intervention (PCI) in patients with rheumatoid arthritis (RA) and coronary heart disease. We identified 25,367 patients from the National Health Insurance Research Database who underwent nonstenting PCI in Taiwan in 2007. Of these patients, 240 had been diagnosed with RA. As a comparison group, we selected 1,200 patients who were matched with the study group by gender and age. We performed conditional logistic regression analysis to compare the outcomes of PCI between the 2 groups. We found no significant differences in the rates of in-hospital mortality (2.5% vs 3.1%, p = 0.628), 90-day readmission for PCI (8.3% vs 7.2%, p = 0.559), or 365-day readmission for PCI (22.5% vs 19.2%, p = 0.236) between the patients with and without RA. Similarly, the conditional logistic regression analyses revealed that patients with RA had no greater adjusted odds of in-hospital mortality (odds ratio 0.94, 95% confidence interval 0.37 to 2.36), 90-day readmission for PCI (odds ratio 1.20, 95% confidence interval 0.37 to 2.36), and 365-day readmission for PCI (odds ratio 1.30, 95% confidence interval 0.92 to 1.83) than the comparison group. In conclusion, our study did not find an increased risk of adverse outcomes among patients with RA after PCI.
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96
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Jolobe OMP. Pharmacogenetic profiling might meet the challenge. J Intern Med 2011; 270:494-5. [PMID: 21819465 DOI: 10.1111/j.1365-2796.2011.02436.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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97
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Prete M, Racanelli V, Digiglio L, Vacca A, Dammacco F, Perosa F. Extra-articular manifestations of rheumatoid arthritis: An update. Autoimmun Rev 2011; 11:123-31. [PMID: 21939785 DOI: 10.1016/j.autrev.2011.09.001] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 09/03/2011] [Indexed: 12/13/2022]
Abstract
Rheumatoid arthritis (RA) is an immune-mediated disease involving chronic low-grade inflammation that may progressively lead to joint destruction, deformity, disability and even death. Despite its predominant osteoarticular and periarticular manifestations, RA is a systemic disease often associated with cutaneous and organ-specific extra-articular manifestations (EAM). Despite the fact that EAM have been studied in numerous RA cohorts, there is no uniformity in their definition or classification. This paper reviews current knowledge about EAM in terms of frequency, clinical aspects and current therapeutic approaches. In an initial attempt at a classification, we separated EAM from RA co-morbidities and from general, constitutional manifestations of systemic inflammation. Moreover, we distinguished EAM into cutaneous and visceral forms, both severe and not severe. In aggregated data from 12 large RA cohorts, patients with EAM, especially the severe forms, were found to have greater co-morbidity and mortality than patients without EAM. Understanding the complexity of EAM and their management remains a challenge for clinicians, especially since the effectiveness of drug therapy on EAM has not been systematically evaluated in randomized clinical trials.
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Affiliation(s)
- Marcella Prete
- Department of Internal Medicine and Clinical Oncology, University of Bari Medical School, Piazza G. Cesare 11, Bari, Italy
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98
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Feuillet S, Tazi A. [Acute interstitial pneumonia: diagnostic approach and management]. Rev Mal Respir 2011; 28:809-22. [PMID: 21742242 DOI: 10.1016/j.rmr.2011.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 01/27/2011] [Indexed: 01/15/2023]
Abstract
Acute interstitial pneumonia (AIP) encompasses a spectrum of pulmonary disorders characterized by involvement of the lung interstitium and distal airways (bronchioles and alveoli). The onset of respiratory symptoms is acute, most often within two weeks. Most AIP take place de novo, but sometimes represent an acute exacerbation of chronic lung disease. The clinical presentation of AIP comprises rapidly progressive dyspnoea, associated sometimes with cough, fever, myalgia and asthenia. Chest radiography shows diffuse pulmonary opacities. The associated hypoxemia may be severe enough to cause acute respiratory failure. Underlying aetiologies are numerous and variable, particularly in relation to the underlying immune status of the host. Various histopathological entities may be responsible for AIP although diffuse alveolar damage is the predominant pattern. The diagnostic approach to a patient presenting with AIP is to try to determine the most likely underlying histopathological pattern and to search for a precise aetiology. It relies mainly on a meticulous clinical evaluation and accurate biological investigation, essentially guided by the results of bronchoalveolar lavage performed in an area identified by abnormalities on high resolution computed tomography of the lungs. Initial therapeutic management includes symptomatic measures, broad-spectrum antibiotic treatment adapted to the clinical context, frequently combined with systemic corticosteroid therapy.
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Affiliation(s)
- S Feuillet
- Service de pneumologie, hôpital Saint-Louis, université Denis-Diderot, AP-HP, Paris cedex 10, France
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Soh MC, Hart HH, Corkill M. Pericardial effusions with tamponade and visceral constriction in patients with rheumatoid arthritis on tumour necrosis factor (TNF)-inhibitor therapy. Int J Rheum Dis 2010; 12:74-7. [PMID: 20374322 DOI: 10.1111/j.1756-185x.2009.01387.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Tumour necrosis factor-inhibitor (TNF-inhibitor) therapy is increasingly used for the treatment of rheumatoid arthritis. While it is effective for the articular manifestations of rheumatoid arthritis we have reason to believe that it is less effective for extra-articular disease. We present two cases of life-threatening cardiac tamponade in two patients with well-controlled rheumatoid arthritis on adalimumab. An extensive literature search was carried out and three other patients were found. We believe that these cases highlight the need for rheumatologists to be vigilant for extra-articular manifestations of rheumatoid arthritis even in the presence of quiescent joint disease while on TNF-inhibitors.
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Affiliation(s)
- May Ching Soh
- Waitemata District Health Board, Auckland, New Zealand
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100
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Jiamsripong P, Mookadam F, Oh JK, Khandheria BK. Spectrum of pericardial disease: part II. Expert Rev Cardiovasc Ther 2009; 7:1159-69. [PMID: 19764867 DOI: 10.1586/erc.09.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pericardial disease is a common disorder seen in varying clinical settings, and may be the first manifestation of an underlying systemic disease. In part I, we focused on the current knowledge and management of the more common pericardial diseases: acute pericarditis, pericardial effusion, cardiac tamponade, chronic pericarditis and relapsing pericarditis. In part II, we will focus on the knowledge and management of pericardial involvement in chylous pericardial effusion cholesterol pericarditis, radiation pericarditis, pericardial involvement in systemic inflammatory diseases, autoreactive pericarditis, pericarditis in renal failure, pericardial constriction and effusive constrictive pericarditis.
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Affiliation(s)
- Panupong Jiamsripong
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Scottsdale, AZ 85259, USA.
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