Heart Involvement in Inflammatory Rheumatic Diseases: A Systematic Literature Review

Introduction: Patients with inflammatory rheumatic diseases have an increased risk of developing cardiovascular manifestations. The high risk of cardiovascular pathology in these patients is not only due to traditional cardiovascular risk factors (age, gender, family history, smoking, sedentary lifestyle, cholesterol), but also to chronic inflammation and autoimmunity. Aim: In this review, we present the mechanisms of cardiovascular comorbidities associated with inflammatory rheumatic diseases, as they have recently been reported by different authors, grouped in electrical abnormalities, valvular, myocardial and pericardial modifications and vascular involvement. Methods: We conducted a systematic search of published literature on the following online databases: EBSCO, ScienceDirect, Scopus and PubMed. Searches were limited to full-text English-language journal articles published between 2010 and 2017 using the following key words: heart, systemic inflammation, autoimmunity, rheumatic diseases and disease activity. After the primary analysis we included 50 scientific articles in this review. Results: The results showed that cardiac manifestations of systemic inflammation can occur frequently with different prevalence in rheumatoid arthritis (RA), systemic lupus erythematosus(SLE), systemic sclerosis(SSc) and ankylosing spondylitis(AS). Rheumatologic diseases can affect the myocardium, cardiac valves, pericardium, conduction system and arterial vasculature. Conclusions: Early detection, adequate management and therapy of specific cardiac involvement are essential in rheumatic disease. Electrocardiographic and echocardiographic evaluation should be performed as routine investigations in patients with inflammatory rheumatic diseases.

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Risk of severe coronavirus infection (COVID-19) in patients with inflammatory rheumatic diseases.

The Journal of Rheumatology ◽

10.3899/jrheum.200755 ◽

2021 ◽

pp. jrheum.200755

Author(s):

Javier Bachiller-Corral ◽

Alina Boteanu ◽

Maria Jesus Garcia-Villanueva ◽

Carlos de la Puente ◽

Marcelino Revenga ◽

...

Keyword(s):

General Population ◽

Rheumatic Diseases ◽

Lupus Erythematosus ◽

Severe Pneumonia ◽

Inflammatory Rheumatic Diseases ◽

Jak Inhibitors ◽

Increased Risk ◽

Conventional Dmards ◽

Coronavirus Infection ◽

Single Center Observational Study

Objective To describe the cohort of patients with inflammatory rheumatic diseases (IRD) hospitalized due to SARS-CoV-2 infection in our hospital and to determine the increased risk of severe coronavirus disease regarding no IRD patients. Methods Retrospective single-center observational study of patients with IRD actively monitored in the Department of Rheumatology who were hospitalized due to COVID- 19. Results 41 (1,8%) out of 2,315 patients admitted due to severe SARS-CoV-2 pneumonia suffered from an IRD. The admission Odds ratio (OR) for IRD patients was 1.87 against the general population, and it was higher in patients with Sjögren’s syndrome, vasculitis and systemic lupus erythematosus. Twenty-seven patients were receiving treatment for IRD with corticosteroids, 23 with conventional DMARDs, 12 with biologics (7 rituximab, 4 anti-TNF and 1 abatacept) and 1 with JAK inhibitors. Ten deaths were registered among patients with IRD. A higher hospitalization rate and a higher number of deaths were observed in patients treated with rituximab (OR=12.8) but not in patients treated with anti-TNF (OR=0.9). Conclusion Patients with IRD, especially autoimmune diseases and patients treated with rituximab, may be at higher risk of severe pneumonia due to SARS-Cov 2, compared to the general population. More studies are needed to analyze this association further in order to help managing these patients during the pandemic.

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Novel gene variants associated with cardiovascular disease in systemic lupus erythematosus and rheumatoid arthritis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-212614 ◽

2018 ◽

Vol 77 (7) ◽

pp. 1063-1069 ◽

Cited By ~ 8

Author(s):

Dag Leonard ◽

Elisabet Svenungsson ◽

Johanna Dahlqvist ◽

Andrei Alexsson ◽

Lisbeth Ärlestig ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

General Population ◽

Lupus Erythematosus ◽

Risk Allele ◽

Snp Array ◽

Inflammatory Rheumatic Diseases ◽

Systemic Lupus ◽

Increased Risk

ObjectivesPatients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) have increased risk of cardiovascular disease (CVD). We investigated whether single nucleotide polymorphisms (SNPs) at autoimmunity risk loci were associated with CVD in SLE and RA.MethodsPatients with SLE (n=1045) were genotyped using the 200K Immunochip SNP array (Illumina). The allele frequency was compared between patients with and without different manifestations of CVD. Results were replicated in a second SLE cohort (n=1043) and in an RA cohort (n=824). We analysed publicly available genetic data from general population, performed electrophoretic mobility shift assays and measured cytokine levels and occurrence of antiphospholipid antibodies (aPLs).ResultsWe identified two new putative risk loci associated with increased risk for CVD in two SLE populations, which remained after adjustment for traditional CVD risk factors. An IL19 risk allele, rs17581834(T) was associated with stroke/myocardial infarction (MI) in SLE (OR 2.3 (1.5 to 3.4), P=8.5×10−5) and RA (OR 2.8 (1.4 to 5.6), P=3.8×10−3), meta-analysis (OR 2.5 (2.0 to 2.9), P=3.5×10−7), but not in population controls. The IL19 risk allele affected protein binding, and SLE patients with the risk allele had increased levels of plasma-IL10 (P=0.004) and aPL (P=0.01). An SRP54-AS1 risk allele, rs799454(G) was associated with stroke/transient ischaemic attack in SLE (OR 1.7 (1.3 to 2.2), P=2.5×10−5) but not in RA. The SRP54-AS1 risk allele is an expression quantitative trait locus for four genes.ConclusionsThe IL19 risk allele was associated with stroke/MI in SLE and RA, but not in the general population, indicating that shared immune pathways may be involved in the CVD pathogenesis in inflammatory rheumatic diseases.

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How to taper glucocorticoids in inflammatory rheumatic diseases? A narrative review of novel evidence in rheumatoid arthritis, systemic lupus erythematosus, and giant cell arteritis

Joint Bone Spine ◽

10.1016/j.jbspin.2021.105285 ◽

2021 ◽

pp. 105285

Author(s):

Frank Buttgereit ◽

Andriko Palmowski

Keyword(s):

Rheumatoid Arthritis ◽

Systemic Lupus Erythematosus ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Rheumatic Diseases ◽

Lupus Erythematosus ◽

Narrative Review ◽

Inflammatory Rheumatic Diseases ◽

Systemic Lupus

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Chronic obstructive pulmonary disease and rheumatic diseases: A systematic review on a neglected comorbidity

Journal of Comorbidity ◽

10.1177/2235042x18820209 ◽

2019 ◽

Vol 9 ◽

pp. 2235042X1882020 ◽

Cited By ~ 3

Author(s):

Irini Gergianaki ◽

Ioanna Tsiligianni

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Rheumatic Diseases ◽

Lupus Erythematosus ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Primary Sjögren Syndrome ◽

Copd Patients ◽

Increased Risk ◽

Health Quality

Background: Although, both chronic obstructive pulmonary disease (COPD) and rheumatic diseases (RDs) are common, and each has significant impact on patients’ overall health/quality of life, their co-occurrence has received little attention, while 15% of COPD remains undiagnosed in RDs. Objective: To update the information regarding the comorbid state of RD/COPD (prevalence, incidence), to examine whether patients with RD have increased risk of developing COPD and vice versa, and what implications this comorbidity has on patients’ outcomes (mortality, hospitalizations, exacerbations). Methods: We performed a systematic literature review regarding the comorbidity of an RD (rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), primary Sjogren syndrome disease (pSS), and systemic sclerosis (SSc)) with COPD. From 2803 reports retrieved, 33 articles were further screened. Finally, 27 articles were included. Results: Robust evidence supports that COPD develops up to 68% more frequently in patients with RA, as compared to the general population. Similarly, COPD is increased in every other RD that was studied. Further, self-referred arthritis is more common in COPD patients versus non-COPD controls and a predictor of worst self-rated health status. Patients with inflammatory arthritis/COPD have increased mortality (threefold in RA-COPD, irrespectively of which is first diagnosed), hospitalizations, and emergency visits. Conclusion: COPD is more common in patients with RA, AS, PsA, SLE, pSS, and SSc; yet, the association, vice versa, warrants further investigation. Nevertheless, COPD/RDs coexistence has significant prognostic value for worst outcomes; therefore, awareness is required to track early identification, especially in primary care.

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Methods to improve medication adherence in patients with chronic inflammatory rheumatic diseases: a systematic literature review

RMD Open ◽

10.1136/rmdopen-2018-000684 ◽

2018 ◽

Vol 4 (2) ◽

pp. e000684 ◽

Cited By ~ 14

Author(s):

Matthieu Lavielle ◽

Déborah Puyraimond-Zemmour ◽

Xavier Romand ◽

Laure Gossec ◽

Eric Senbel ◽

...

Keyword(s):

Medication Adherence ◽

Literature Review ◽

Rheumatic Diseases ◽

Systematic Literature Review ◽

Lupus Erythematosus ◽

Connective Tissue Diseases ◽

Educational Interventions ◽

Inflammatory Rheumatic Diseases ◽

Improve Medication Adherence ◽

Chronic Inflammatory Rheumatic Diseases

ObjectiveLack of adherence to treatment is frequent in chronic inflammatory rheumatic diseases and is associated with poorer outcomes. The objective of this study was to describe and evaluate interventions that have been proposed to enhance medication adherence in these conditions.MethodsA systematic literature review was performed in Pubmed, Cochrane, Embase and clinicaltrials.gov databases completed by the rheumatology meeting (ACR, EULAR and SFR) abstracts from last 2 years. All studies in English or French evaluating an intervention to improve medication adherence in chronic inflammatory rheumatic diseases (rheumatoid arthritis (RA), spondyloarthritis (SpA), crystal related diseases, connective tissue diseases, vasculitis and Still’s disease) were included. Interventions on adherence were collected and classified in five modalities (educational, behavioural, cognitive behavioural, multicomponent interventions or others).Results1325 abstracts were identified and 22 studies were finally included (18 studies in RA (72%), 4 studies in systemic lupus erythematosus (16%), 2 studies in SpA (8%) and 1 study in gout (4%)). On 13 randomised controlled trials (RCT) (1535 patients), only 5 were positive (774 patients). Educational interventions were the most represented and had the highest level of evidence: 8/13 RCT (62%, 1017 patients) and 4/8 were positive (50%). In these studies, each patient was individually informed or educated by different actors (physicians, pharmacists, nurses and so on). Supports and contents of these educational interventions were heterogenous.ConclusionDespite the importance of medication adherence in chronic inflammatory rheumatic disorders, evidence on interventions to improve medication adherence is scarce.

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Favourable antibody responses to human coronaviruses in children and adolescents with autoimmune rheumatic diseases

10.1101/2021.02.15.431291 ◽

2021 ◽

Author(s):

Claire T. Deakin ◽

Georgina H. Cornish ◽

Kevin W. Ng ◽

Nikhil Faulkner ◽

William Bolland ◽

...

Keyword(s):

Children And Adolescents ◽

Rheumatic Diseases ◽

Lupus Erythematosus ◽

Immunosuppressive Treatment ◽

Immune Dysfunction ◽

Inflammatory Rheumatic Diseases ◽

Igg Antibodies ◽

Autoimmune Rheumatic Diseases ◽

Human Coronaviruses ◽

The Impact

AbstractDifferences in humoral immunity to coronaviruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), between children and adults remain unexplained and the impact of underlying immune dysfunction or suppression unknown. Here, we examined the antibody immune competence of children and adolescents with prevalent inflammatory rheumatic diseases, juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDM) and juvenile systemic lupus erythematosus (JSLE), against the seasonal human coronavirus (HCoV)-OC43 that frequently infects this age group. Despite immune dysfunction and immunosuppressive treatment, JIA, JDM and JSLE patients mounted comparable or stronger responses than healthier peers, dominated by IgG antibodies to HCoV-OC43 spike, and harboured IgG antibodies that cross-reacted with SARS-CoV-2 spike. In contrast, responses to HCoV-OC43 and SARS-CoV-2 nucleoproteins exhibited delayed age-dependent class-switching and were not elevated in JIA, JDM and JSLE patients, arguing against increased exposure. Consequently, autoimmune rheumatic diseases and their treatment were associated with a favourable ratio of spike to nucleoprotein antibodies.

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Features of inflammatory rheumatic diseases treatment in older people

Russian Journal of Geriatric Medicine ◽

10.37586/2686-8636-3-2021-319-331 ◽

2021 ◽

pp. 327-339

Author(s):

A. D. Meshkov ◽

V. S. Ostapenko

Keyword(s):

Older People ◽

Rheumatic Diseases ◽

Treatment Options ◽

Interdisciplinary Approach ◽

Immunosuppressive Drugs ◽

Inflammatory Rheumatic Diseases ◽

Synthetic Drugs ◽

Iatrogenic Complications ◽

Increased Risk ◽

The One

Currently the number of older people with chronic rheumatic diseases is increasing. Distinctive features of this population are the increased risk of cardiovascular and infectious diseases, tumours, as well as iatrogenic complications, while this group of patients is rather heterogeneous. On the one hand, modern biological and targeted synthetic drugs, provide new, previously inaccessible, treatment options; on the other hand, their use is associated with risk of side effects. In this review specifics of prescribing immunosuppressive drugs in older patients with rheumatoid arthritis and spondyloarthritis has been analyzed. An effective and safe approach to the use of these drugs in older people can be based on a comprehensive interdisciplinary approach, taking into account geriatric characteristics of the patients.

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New directions of pharmacotherapy of immune - inflammatory rheumatic diseases

Terapevticheskii arkhiv ◽

10.26442/00403660.2019.08.000406 ◽

2019 ◽

Vol 91 (8) ◽

pp. 98-107 ◽

Cited By ~ 1

Author(s):

E L Nasonov

Keyword(s):

Rheumatic Diseases ◽

Lupus Erythematosus ◽

Kinase Inhibitors ◽

Systemic Vasculitis ◽

Janus Kinase ◽

Inflammatory Rheumatic Diseases ◽

Dramatic Improvement ◽

Janus Kinase Inhibitors ◽

Autoimmune Pathology ◽

Factor Α

Deciphering immunopathogenesis, expanding the scope of diagnostics and developing new methods for treating human autoimmune diseases are among the priority areas of XXI century medicine. Particularly widely autoimmune pathology is presented in immunoinflammatory rheumatic diseases (IIRD), such as rheumatoid arthritis, systemic lupus erythematosus, systemic scleroderma, systemic vasculitis associated with the synthesis of antineutrophilic cytoplasmic antibodies, Sjogren's syndrome, idiopathic inflammatory myopathies and other other types of others. Deciphering the pathogenesis mechanisms of IIRD created the prerequisites for improving pharmacotherapy, which in the future should lead to a dramatic improvement in the prognosis for these diseases. The review discusses new approaches to IIRD pharmacotherapy associated with the inhibition of tumor necrosis factor-α, interleukin-6 (IL-6), IL-1β, IL-17, IL-23, and the prospects for using Janus kinase inhibitors, depending on the prevailing pathogenesis mechanisms - autoimmunity or autoinflammation.

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