Manual Rheumatic Diseases and the Heart

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It has been established that all structures of the heart can be affected due to the long-term systemic inflammation and specific autoimmune and autoinflammatory factors [ 1 ]. Classic clinical models of cardiovascular phenomenon in rheumatic diseases are rheumatoid arthritis RA and systemic lupus erythematosus SLE , which are associated with enhanced course of atherosclerosis and various atherothrombotic events.

Numerous large cohort studies of RA and SLE have provided evidence of atypical and severe course of myocardial infarction and heart failure in these autoimmune diseases, necessitating specific early diagnostic and preventive approaches. The intensity of systemic inflammation confounds cardiovascular manifestations across rheumatic diseases.

Drug Therapy for Rheumatic Disease | Cedars-Sinai

Accordingly, inflammation-induced atherosclerosis is believed to be a more pressing issue in RA and SLE than in autoinflammatory disorders [ 2 ]. Methotrexate therapy improves lipid profiles and reduces atherothrombotic risk in RA by diminishing production of C-reactive protein CRP and suppressing systemic inflammation [ 3 ].

What are juvenile arthritis and other rheumatic diseases?

Biologic agents may also protect from enhanced atherogenesis in RA by potently suppressing pro-inflammatory cytokines, such as interleukin-6 and tumor necrosis factor alpha [ 4 ]. Although there are no specifically designed trials of colchicine therapy in atherogenesis due autoinflammatory disorders, this anti-neutrophilic agent is viewed as cardioprotective and essential for cohorts of patients with inflammatory amyloidosis and pericarditis [ 5 ].

Case series and pilot cohort studies of atherogenesis in vasculitides provide variable results, which may be related to the intensity of systemic inflammation, specific pathogenic factors, and differing anti-inflammatory therapies, some of which, and particularly glucocorticosteroids, may adversely affect lipid profiles, glucose and insulin levels, platelet function, and other thrombotic factors. Likewise, macrovascular atherosclerotic disease was not enhanced in giant cell arteritis [ 7 ]. Nonetheless, when compared with SLE, patients with Takayasu arteritis TA had more atherosclerotic plaques despite comparable cardiovascular risk factors [ 8 ].

Beyond the Joint: Mechanisms and Management of Central Pain in Systemic Rheumatic Diseases

There have been several attempts to propose markers for early diagnosis and monitoring of cardiovascular disease in rheumatic disorders. Most related studies have focused on RA.


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One of the well-designed prospective cohort studies with RA patients, who were followed from to , proved that carotid plaques, intima-media thickness, and aortic pulse wave velocity predict cardiovascular events [ 9 ]. The role of many other vascular and cellular markers for predicting the course of cardiovascular disease and heart failure in inflammatory rheumatic diseases still remains poorly explored and not validated.


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The issue is further complicated with uncertainties associated with predictive value of vascular markers in case of combination of rheumatic diseases, other comorbidities, and across various age and ethnic cohorts. Vascular marker studies are predominantly conducted in the USA and Western Europe and are hardly applicable in the rest of the world. European recommendations of cardiovascular risk assessment and management in rheumatic diseases are currently available and are largely based on cohort studies of RA. These recommendations may be applicable to ankylosing spondyloarthritis AS and psoriatic arthritis PsA , though related evidence-base is still not as strong as in RA.

Rheumatic Disease Drug Therapy

Typically, symptoms of rheumatic fever appear about two weeks after the onset of an untreated strep throat infection. Apart from the sore throat caused by the strep infection, children have a fever and feel ill. Commonly, the child will have a very painful, swollen and red joint — usually a large joint like a knee, ankle, elbow or shoulder — that goes away after a day or two only to be replaced by the same problem in another joint.

Short-lived skin rashes may occur, but are not common. Even if the heart is affected, it is usually not severe enough to cause symptoms, although occasionally the child may be short of breath. The first step in diagnosing rheumatic heart disease is establishing that your child recently had a strep infection.

Rheumatic Heart Disease

The doctor may order a throat culture , a blood test, or both to check for the presence of strep antibodies. However, it is likely that signs of the strep infection may be gone by the time you take your child to the doctor. In that case, the doctor will need you to try to remember if your child recently had a sore throat or other symptoms of a strep infection. The doctor will do a physical examination and check your child for signs of rheumatic fever, including joint pain and inflammation. The doctor also will listen to your child's heart to check for abnormal rhythms or murmurs that may signify that the heart has been strained.


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In addition, there are a couple of tests that may be used to check the heart and assess damage, including:. Although having rheumatic fever leaves a child more susceptible to heart damage, it does not always permanently damage the heart.

What is RHD?: In Focus

However, when the inflammation caused by rheumatic fever leaves one or more of the heart valves scarred, the result is rheumatic heart disease. The mitral valve and the aortic valve are usually the ones damaged by the disease. Years later, the mitral valve may become narrowed, a condition known as mitral stenosis.