Total Eclipse of the Heart
The hallmark of the autoimmune rheumatic diseases is their involvement of multiple organ systems. Whilst perhaps the more apparent manifestations of these diseases, such as skin or joint involvement dominate clinical management, cardiovascular (CV) manifestations of rheumatological diseases have become increasingly recognised, and their impact on morbidity and mortality cannot be ignored. Furthermore, the propensity towards early or accelerated atherosclerosis via multiple mechanisms (including inflammation, endothelial dysfunction and immune dysregulation), is a major contributor to morbidity and highlights the need to raise awareness of cardiovascular disease (CVD) in this patient population.
Rheumatic fever: Licks the joints but bites the heart
A retaeus in the 2nd century BC was probably the first to make reference to acute rheumatic fever (ARF). The first clear description was made by Guillaume Baillou in 1616 who stated "In those in whom pains and swellings come and go around the joints, and these not after the manner of gout in the foot, one will find large viscera…Now this disease occurs in those in childhood and youth …".
Bite of the Wolf: Lupus and the Heart
Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease with a wide spectrum of clinical and serological manifestations. It is associated with autoantibody production, complement activation, and immune complex deposition. The etiopathogenesis of SLE is not entirely clear but is thought to involve complex interactions between genetic and hormonal factors, and environmental exposures. The assessment and management of lupus is often challenging as the disease can be unpredictable, affect multiple organs to a variable degree and be complicated by organ damage and comorbidities. Symptoms range in severity from subclinical to life-threatening, reflecting the etiological heterogeneity of SLE.
Cardiac sarcoidosis: An unrecognised killer
Cardiac sarcoidosis (CS) is a multisystem granulomatous disease of unknown aetiology. Current evidence suggests the participation of an immunological response to an unidentified antigenic trigger, to be essential in disease development. When spontaneous resolution does not occur or if left untreated granulomatous inflammation leads to fibrosis and end-organ damage. Systemic sarcoidosis primarily affects adults, with the highest peak in women over 50 years.1 The cardiovascular system is the third most implicated system.
‘tis the heart of the matter, is the matter of the heart” Cardiovascular manifestations of Kawasaki disease
“The heart’s key is the door of the soul”
In Kawasaki disease (KD), the cardiovascular system is the key organ associated with significant mortality and morbidity, both during the acute illness and in the long term. Thus, prompt and accurate recognition and management are essential.
Towards performing carotid and femoral artery ultrasound in patients with rheumatic diseases
cardiovascular events together with neoplasms are the non-communicable diseases that account for most of mortality worldwide. Prevention of cardiovascular disease (CVD) by treating its risk factors is crucial as it is both highly effective and far less costly than treating its complications. An increased risk of atherosclerotic cardiovascular mortality in patients with rheumatoid arthritis (RA) was first documented as far back as 1976.3 Many subsequent investigations confirmed a substantially increased risk of both atherosclerotic cardiovascular event and mortality rates in RA.3,4 More recent work has shown that among rheumatic disease patients, it is not only those with RA that are at increased risk of atherosclerotic cardiovascular morbidity and mortality. Patients with spondyloarthritis (SpA) including psoriatic arthritis (PsoA), ankylosing spondyloarthritis and non-radiographic axial SpA (axSpA),5,6 lupus7 and gout8,9 as well as osteoarthritis (OA)10 and fibromyalgia (FM)11 all have an increased atherosclerotic CVD risk. This argues towards the need for routine and adequate cardiovascular risk management in all patients with rheumatic diseases.
IL-17 inhibitors: The New Kid on the Biologics Block
In 2019, SAPHRA approved secukinumab, a fully human, IL-17A inhibitor for the treatment of moderate-severe plaque psoriasis (PsO), psoriatic arthritis (PsA) and refractory axial spondyloarthritis (AxSpA). This therapy is now well established in the South African (SA) rheumatology space, with over 100 patients using this treatment, based on data from the SARAA biologics registry.
Educating Young Rheumatologists
The second Regional SARAA Young Rheumatologist Forum (YRF) meeting was held with great success at the Maslow Hotel in Sandton, Johannesburg on the 2nd of October 2021. A special thanks to Novartis for collaborating on this highly successful meeting for fellows and junior rheumatologists.
Health Professions Council of South Africa
Attempts allowed: 2
70% pass rate
News Rheum - Vol 3 No 1 - March/April 2022