Clinical Presentations in Cardio-Rheumatology
Özet
Rheumatic diseases significantly impact the cardiovascular system, leading to increased morbidity and mortality. Chronic inflammation, autoimmune mechanisms, and vascular involvement contribute to a wide range of cardiac complications, including atherosclerosis, myocardial dysfunction, pericarditis, valvular abnormalities, and arrhythmias. Both large and small blood vessels can be affected, resulting in ischemic and non-ischemic heart disease, hypertension, and thrombotic events.
The relationship between rheumatic diseases and cardiovascular risk is complex, influenced by disease activity, immune-mediated damage, and traditional cardiovascular risk factors. Early diagnosis and management are essential to prevent severe complications such as heart failure, myocardial infarction, and sudden cardiac death. Regular cardiovascular screening, lifestyle modifications, and targeted pharmacological treatments play a crucial role in improving patient outcomes.
Romatizmal hastalıklar kardiyovasküler sistemi önemli ölçüde etkileyerek morbidite ve mortaliteyi artırır. Kronik inflamasyon, otoimmün mekanizmalar ve damar tutulumu, ateroskleroz, miyokard disfonksiyonu, perikardit, kapak hastalıkları ve aritmiler gibi çeşitli kardiyak komplikasyonlara yol açar. Büyük ve küçük damarlar etkilenerek iskemik ve non-iskemik kalp hastalıkları, hipertansiyon ve trombotik olaylar gelişebilir.
Romatizmal hastalıklar ve kardiyovasküler risk arasındaki ilişki karmaşıktır ve hastalık aktivitesi, bağışıklık sisteminin verdiği hasar ve geleneksel risk faktörlerinden etkilenir. Kalp yetmezliği, miyokard enfarktüsü ve ani kardiyak ölüm gibi ciddi komplikasyonları önlemek için erken teşhis ve etkin tedavi önemlidir. Düzenli kardiyovasküler taramalar, yaşam tarzı değişiklikleri ve hedefe yönelik farmakolojik tedaviler, hastaların sağkalımını artırmada kritik rol oynar.
Referanslar
Błyszczuk P, Szekanecz Z. Pathogenesis of ischaemic and non-ischaemic heart diseases in rheumatoid arthritis. Rheumatic & Musculoskeletal Diseases Open. 2020;6(1):e001032. doi: 10.1136/rmdopen-2019-001032.
Avina-Zubieta JA, Thomas J, Sadatsafavi M, et al. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies. Annals of the Rheumatic Diseases. 2012;71(9):1524-1529. doi: 10.1136/annrheumdis-2011-200726.
Aviña-Zubieta JA, Choi HK, Sadatsafavi M, et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis and Rheumatism. 2008;59(12):1690-1697. doi: 10.1002/art.24092.
Agca R, Heslinga SC, Rollefstad S, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Annals of the Rheumatic Diseases. 2017;76:17–28. doi:10.1136/annrheumdis-2016-209775.
Majka DS, Vu TT, Pope RM, et al. Association of rheumatoid factors with subclinical and clinical atherosclerosis in African American women: the multiethnic study of atherosclerosis. Arthritis Care & Research. 2017;69(2):166-174. doi: 10.1002/acr.22930.
Park E, Ito K, Iqbal R, et al. Prospective changes in diastolic function in patients with rheumatoid arthritis. Arthritis Research & Therapy. 2022;24(1):184. doi: 10.1186/s13075-022-02864-0.
Park E, Griffin J, Bathon JM. Myocardial dysfunction and heart failure in rheumatoid arthritis. Arthritis & Rheumatology. 2022;74(2):184-199. doi: 10.1002/art.41979.
Buleu F, Sirbu E, Caraba A, et al. Heart Involvement in Inflammatory Rheumatic Diseases: A Systematic Literature Review. Medicina (Kaunas). 2019;55(6):249. doi: 10.3390/medicina55060249.
Guedes C, Bianchi-Fior P, Cormier B, et al. Cardiac manifestations of rheumatoid arthritis: a case-control transesophageal echocardiography study in 30 patients. Arthritis and Rheumatism. 2001;45(2):129-135. doi: 10.1002/1529-0131(200104)45:2<129::AID-ANR164>3.0.CO;2-K.
Seferović PM, Ristić AD, Maksimović R, et al. Cardiac arrhythmias and conduction disturbances in autoimmune rheumatic diseases. Rheumatology (Oxford). 2006;45(4):39-42. doi: 10.1093/rheumatology/kel315.
Lindhardsen J, Ahlehoff O, Gislason GH, et al. Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study. BMJ. 2012;344:e1257. doi: 10.1136/bmj.e1257.
Villecco AS, de Liberali E, Bianchi FB, Pisi E. Antibodies to cardiac conducting tissue and abnormalities of cardiac conduction in rheumatoid arthritis. Clinical and Experimental Immunology. 1983;53(3):536-540.
Roman MJ, Salmon JE. Cardiovascular manifestations of rheumatologic diseases. Circulation. 2007;116(20):2346-2355. doi: 10.1161/CIRCULATIONAHA.106.678334.
Prasad M., Hermann J., Gabriel S.E., et al. Cardiorheumatology: Cardiac involvement in systemic rheumatic disease. Nature reviews, Cardiology. 2015;12:168–176. doi: 10.1038/nrcardio.2014.206
Watad A, Tiosano S, Grysman N, et al. The association between systemic lupus erythematosus and valvular heart disease: an extensive data analysis. European Journal of Clinical Investigation. 2017;47(5):366-371. doi: 10.1111/eci.12744.
Moyssakis I, Tektonidou MG, Vasilliou VA, et al. Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. The American Journal of Medicine. 2007;120(7):636-642. doi: 10.1016/j.amjmed.2007.01.024.
Owlia M.B., Mostafavi Pour Manshadi S.M., Naderi N. Cardiac manifestations of rheumatological conditions: A narrative review. ISRN Rheumatology. 2012;2012:463620. doi: 10.5402/2012/463620.
Ferreira E, Bettencourt PM, Moura LM. Valvular lesions in patients with systemic lupus erythematosus and antiphospholipid syndrome: an old disease but a persistent challenge. Revista Portuguesa de Cardiologia. 2012;31(4):295-299. doi: 10.1016/j.repc.2012.02.005.
Teixeira R.A., Borba E.F., Pedrosa A., et al. Evidence for cardiac safety and antiarrhythmic potential of chloroquine in systemic lupus erythematosus. Europace. 2014;16:887–992. doi: 10.1093/europace/eut290.
Myung G, Forbess LJ, Ishimori ML, Chugh S, Wallace D, Weisman MH. Prevalence of resting-ECG abnormalities in systemic lupus erythematosus: a single-center experience. Clinical Rheumatology. 2017;36(6):1311-1316. doi: 10.1007/s10067-017-3582-0.
Seferović PM, Ristić AD, Maksimović R, et al. Cardiac arrhythmias and conduction disturbances in autoimmune rheumatic diseases. Rheumatology (Oxford). 2006;45(4):39-42. doi: 10.1093/rheumatology/kel315.
Magder LS, Petri M. Incidence of and risk factors for adverse cardiovascular events among patients with systemic lupus erythematosus. American Journal of Epidemiology. 2012;176(8):708-719. doi: 10.1093/aje/kws130.
Maksimowicz-McKinnon K, Selzer F, Manzi S, et al. Poor 1-year outcomes after percutaneous coronary interventions in systemic lupus erythematosus: report from the National Heart, Lung, and Blood Institute Dynamic Registry. Circulation Cardiovascular Interventions. 2008;1(3):201-208. doi: 10.1161/CIRCINTERVENTIONS.108.788745.
Lambova S. Cardiac manifestations in systemic sclerosis. World Journal of Cardiology. 2014;6(9):993-1005. doi: 10.4330/wjc.v6.i9.993.
Kahan A., Coghlan G., McLaughlin V. Cardiac complications of systemic sclerosis. Rheumatology Oxford. 2009;48(3):45–48. doi: 10.1093/rheumatology/kep110.
Roman M.J., Salmon J.E. Cardiovascular manifestations of rheumatologic diseases. Circulation. 2007;116:2346–2355. doi: 10.1161/CIRCULATIONAHA.106.678334.
Cannarile F, Valentini V, Mirabelli G, et al. Cardiovascular disease in systemic sclerosis. Annals of Translational Medicine. 2015;3(1):8. doi: 10.3978/j.issn.2305-5839.2014.12.12.
Dankó K, Ponyi A, Constantin T, et al. Long-term survival of patients with idiopathic inflammatory myopathies according to clinical features: a longitudinal study of 162 cases. Medicine (Baltimore). 2004;83(1):35-42. doi: 10.1097/01.md.0000109755.65914.5e.
Lundberg IE. The heart in dermatomyositis and polymyositis. Rheumatology (Oxford). 2006;45(4):18-21. doi: 10.1093/rheumatology/kel311.
Baniaamam M, Heslinga SC, Konings TC, et al. Aortic root diameter is associated with HLA-B27: identifying the patient with ankylosing spondylitis at risk for aortic valve regurgitation. Rheumatology International. 2022;42(4):683-688. doi: 10.1007/s00296-021-05040-w.
Roman MJ, Salmon JE. Cardiovascular manifestations of rheumatologic diseases. Circulation. 2007;116(20):2346-2355. doi: 10.1161/CIRCULATIONAHA.106.678334.
Bengtsson K, Forsblad-d'Elia H, Lie E, et al. Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study. Arthritis Research and Therapy. 2017;19(1):102. doi: 10.1186/s13075-017-1315-z.
Nuenninghoff DM, Hunder GG, Christianson TJ, et al. Mortality of large-artery complication (aortic aneurysm, aortic dissection, and/or large-artery stenosis) in patients with giant cell arteritis: a population-based study over 50 years. Arthritis and Rheumatism. 2003;48(12):3532-3537. doi: 10.1002/art.11480.
Miloslavsky E, Unizony S. The heart in vasculitis. Rheumatic Diseases Clinics of North America. 2014;40(1):11-26. doi: 10.1016/j.rdc.2013.10.006.
Li L, Neogi T, Jick S. Giant cell arteritis and vascular disease-risk factors and outcomes: a cohort study using UK Clinical Practice Research Datalink. Rheumatology (Oxford). 2017;56(5):753-762. doi: 10.1093/rheumatology/kew482.
Kang EJ, Kim SM, Choe YH, et al. Takayasu arteritis: assessment of coronary arterial abnormalities with 128-section dual-source CT angiography of the coronary arteries and aorta. Radiology. 2014;270(1):74-81. doi: 10.1148/radiol.13122195.
Pagnoux C, Seror R, Henegar C, et al. Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database. Arthritis and Rheumatism. 2010;62(2):616-626. doi: 10.1002/art.27240.
Schrader ML, Hochman JS, Bulkley BH. The heart in polyarteritis nodosa: a clinicopathologic study. American Heart Journal. 1985;109(6):1353-1359. doi: 10.1016/0002-8703(85)90365-5.
Mavrogeni S, Bratis K, Karanasios E, et al. CMR evaluation of cardiac involvement during the convalescence of Kawasaki disease. JACC Cardiovascular Imaging. 2011;4(10):1140-1141. doi: 10.1016/j.jcmg.2011.04.021.
Cereda AF, Pedrotti P, De Capitani L, et al. Comprehensive evaluation of cardiac involvement in eosinophilic granulomatosis with polyangiitis (EGPA) with cardiac magnetic resonance. European Journal of Internal Medicine. 2017;39:51-56. doi: 10.1016/j.ejim.2016.09.014.
Kechida M, Salah S, Kahloun R, et al. Cardiac and vascular complications of Behçet disease in the Tunisian context: clinical characteristics and predictive factors. Advances in Rheumatology. 2018;58(1):32. doi: 10.1186/s42358-018-0032-x.
Atzeni F, Sarzi-Puttini P, Doria A, et al. Behçet's disease and cardiovascular involvement. Lupus. 2005;14(9):723-726. doi: 10.1191/0961203305lu2208oa.
Owlia MB, Mehrpoor G. Behcet's Disease: New concepts in cardiovascular involvements and future direction for treatment. ISRN Pharmacology. 2012;2012:760484. doi: 10.5402/2012/760484.
