The Heart in Rheumatic, Autoimmune and Inflammatory Diseases

Pathophysiology, Clinical Aspects and Therapeutic Approaches

1st Edition - February 10, 2017
Editor: Udi Nussinovitch
Language: English
Hardback ISBN:
9 7 8 - 0 - 1 2 - 8 0 3 2 6 7 - 1
eBook ISBN:
9 7 8 - 0 - 1 2 - 8 0 3 2 6 8 - 8

The prevalence of autoimmune diseases and rheumatic conditions is constantly increasing. Autoimmune diseases affect approximately 7-10% of the population of the United States, wh… Read more

The Heart in Rheumatic, Autoimmune and Inflammatory Diseases

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The prevalence of autoimmune diseases and rheumatic conditions is constantly increasing. Autoimmune diseases affect approximately 7-10% of the population of the United States, while more than 50,000,000 American adults suffer from some type of arthritis. The Heart in Rheumatic, Autoimmune and Inflammatory Diseases examines the complex mechanisms relating to cardiac diseases from a pathophysiological and clinical point of view. Autoimmune rheumatic diseases can affect the coronary vessels, myocardium, pericardium, heart valves and the conduction system. The diagnosis of these unique cardiac complications necessitates medical awareness and a high index of suspicion. Increased risk of advanced atherosclerosis plays a pivotal role in the development of cardiac diseases in systemic, rheumatic and autoimmune illnesses. Yet, other complex immune medicated mechanisms may contribute to the pathogenesis. Patients' optimal care requires coordination between the primary caregiver, the rheumatologist, immunologist and cardiologist. Screening for cardiovascular risk factors, recognition of high-risk patients and identification of subclinical cardiac conditions are of great importance. Moreover, regulation of inflammation, as well as abnormal immune responses and the initiation of early treatments should be the focus of patient management. A continuous attempt to identify novel therapeutic targets and change the natural history of the underlying disease and its cardiac manifestations is in progress. The book aims at providing the readers with a state of the art collection of up to date information regarding clinically important topics based on experts' perspectives.

This book was a result of an extended coordinated collaboration of one-hundred and fifty-four distinguished scientists from thirty-one countries around the globe.

Part I. Immune Medicated Cardiac Injury, Accelerated Atherosclerosis and the Study of Cardiac Involvements in Systemic Diseases

Chapter 1. Pathophysiology of Autoimmunity and Immune-Mediated Mechanisms in Cardiovascular Diseases

1. Pathophysiology of Autoimmunity
2. Immune-Mediated Mechanisms of Cardiovascular Diseases
3. Conclusions

Chapter 2. Organ-Specific Autoimmune Myocardial Diseases: From Pathogenesis to Diagnosis and Management

1. Introduction
2. Aetiopathogenesis of Myocarditis
3. Clinical Presentation and Diagnosis of Myocarditis
4. Specific Aabs Tests
5. Natural History and Prognostic Factors of Biopsy-Proven Myocarditis
6. Specific Forms of Immune-Mediated Myocarditis
7. Management
8. Future Perspectives: Role of Lymphocitic Subtypes and Cytokine Networks

Chapter 3. Autoantibodies Directed Against G-Protein-Coupled Receptors in Cardiovascular Diseases: Basics and Diagnostics

1. Introduction
2. Diagnostics of Autoantibodies Against G-Protein Coupled Receptors

Chapter 4. Immune-Mediated Accelerated Atherosclerosis

1. Atherosclerosis
2. Association With Autoimmune and Inflammatory Diseases
3. Strategies to Minimize the Risk of Atherosclerosis in Autoimmunity
4. Conclusion

Chapter 5. A Study of Cardiac Function, Atherosclerosis, and Arrhythmogenicity

1. Introduction
2. Endothelium
3. Markers for Atherosclerosis and Endothelial Dysfunction
4. Markers of Aortic Abnormalities
5. Evaluation of Ventricular Geometry and Performance
6. Markers for Cardiac Ischemia and Advanced Coronary Atherosclerosis
7. Markers of Increased Risk for Ventricular Arrhythmias
8. Markers of Increased Risk for Supraventricular Arrhythmias

Part II. Cardiac Manifestations of Inflammatory Arthritis

Chapter 6. Rheumatoid Arthritis

1. Introduction
2. Cardiac Involvement in RA
3. Assessement of Cardiovascular Risk in RA: Noninvasive Assessments of Vascular Health
4. Management of CV Risk in RA
5. Overall Summary and Conclusions

Chapter 7. Juvenile Idiopathic Arthritis

1. Definition
2. Epidemiology
3. Genetics
4. Etiology and Pathogenesis
5. Classification
6. Clinical Manifestations
7. Cardiac Involvement in JIA
8. Studies of Ventricular Function
9. Studies of Arterial Structure and Function and Atherosclerotic Biomarkers
10. Cardiopulmonary Exercise Testing
11. General Management of JIA
12. Cardiac Side Effects of Biologic Therapies
13. Management of MAS
14. Management of Pericarditis and Myocarditis in JIA
15. Conclusions

Chapter 8. Spondyloarthritides: Ankylosing Spondylitis, Psoriatic Arthritis, and Reactive Arthritis

1. Introduction to Spondyloarthritis
2. Spondyloarthritis—An Overview
3. The Heart in Psoriatic Arthritis
4. The Heart in Reactive Arthritis

Chapter 9. Polymyalgia Rheumatica

1. Introduction
2. Clinical Presentation and Diagnostic Criteria
3. Pathophysiology of Polymyalgia Rheumatica Associated Cardiovascular Involvement
4. Cardiac Involvement
5. Treatment Options and Cardiac Implications of Therapy
6. Conclusions

Part III. Cardiac Involvement in Autoimmune and Connective Tissue Diseases

Chapter 10. Systemic Lupus Erythematosus

1. Introduction
2. Clinical Features
3. Antiphospholipid Syndrome
4. Immunologic and Other Laboratory Findings in Systemic Lupus Erythematosus
5. Diagnosis
6. Heart Disease in Systemic Lupus Erythematosus
7. Accelerated Atherosclerosis in Systemic Lupus Erythematosus
8. Therapeutic Approach to Systemic Lupus Erythematosus
9. Prognosis

Chapter 11. Neonatal Lupus

1. Introduction
2. Epidemiology
3. Pathogenesis
4. Clinical Manifestations
5. Dermatologic
6. Gastrointestinal
7. Neurologic
8. Hematologic and Skeletal
9. Diagnosis
10. Treatment
11. Recommendations
12. Prognosis
13. Future Directions

Chapter 12. Sjögren’s Syndrome

1. Introduction
2. Clinical Presentation, Laboratory Features, and Diagnostic Criteria
3. Pathophysiology of Non-amyloidosis Associated Cardiac Involvement
4. Cardiac Involvement
5. Treatment Options and Cardiac Implications of Therapy
6. Conclusions

Chapter 13. Systemic Sclerosis

1. Introduction
2. Prevalence of Cardiac Involvement in Systemic Sclerosis
3. Pathophysiology of Primary Cardiac Involvement in Systemic Sclerosis
4. Cardiac Involvement
5. Evaluation of Cardiac Function
6. Patient Evaluation, Clinical Diagnosis, and Cardiovascular Assessment
7. Treatment
8. Conclusions

Chapter 14. Dermatomyositis and Polymyositis

1. Introduction
2. Clinical Presentation and Diagnostic Criteria
3. Pathophysiology of Cardiac Involvement
4. Cardiac Involvement
5. Considerations for Treatment of Cardiac Disease in IIM
6. Conclusions

Part IV. Cardiac Manifestations Crystal-Induced Arthritis

Chapter 15. Gout

1. Introduction
2. Clinical Presentation and Diagnostic Criteria
3. Pathophysiology of Hyperuricemia, Gout, and Cardiovascular Diseases
4. Cardiac Involvement
5. Treatment Options and Cardiac Implications of Therapy
6. Conclusions

Part V. Cardiac Manifestations of Large Vessel Vasculitides

Chapter 16. Giant Cell Arteritis

1. Introduction
2. Clinical Presentation and Diagnosis
3. Giant Cell Arteritis-Associated Cardiovascular Involvement
4. Treatment Options and Cardiac Implications of Therapy
5. Conclusions

Chapter 17. Takayasu’s Arteritis

1. Introduction
2. Clinical Presentation and Diagnostic Criteria
3. Pathophysiology
4. Cardiac Involvement
5. Treatment Options and Cardiac Implications of Therapy
6. Conclusions

Part VI. Cardiac Manifestations of Medium Vessel Vasculitides

Chapter 18. Polyarteritis Nodosa

1. Introduction
2. Diagnostic Criteria
3. Differential Diagnosis
4. Pathophysiology of Polyarteritis Nodosa
5. Cardiac Involvement
6. Treatment Options and Cardiac Implications of Therapy
7. Conclusions

Chapter 19. Kawasaki Disease

1. History
2. Epidemiology
3. Etiology
4. Pathogenesis
5. Clinical Manifestations
6. Diagnosis
7. Cardiovascular Manifestations
8. Treatment
9. Long-term follow-up and Prognosis
10. Atherosclerosis and Kawasaki Disease
11. Conclusion

Part VII. Cardiac Manifestations of Small Vessel Vasculitides

Chapter 20. ANCA-Associated Vasculitis: Microscopic Polyangiitis, Eosinophilic Granulomatosis With Polyangiitis (Churg–Strauss Syndrome) and Granulomatosis With Polyangiitis (Wegener’s Granulomatosis)

1. Introduction
2. Clinical Presentation and Diagnostic Criteria
3. Vasculitis-Related Cardiac Involvement
4. Prognosis
5. Treatment of AAV and Cardiac Implications of Therapy
6. Conclusion

Part VIII. Cardiac Manifestations of Variable Vessel Vasculitides

Chapter 21. Behçet’s Disease

1. Introduction
2. Clinical Presentation and Diagnostic Criteria
3. Pathophysiology of Thrombosis and Vascular Damage in Behçet’s Disease
4. Cardiac Involvement in Behçet’s Disease
5. Treatment Options and Cardiac Implications of Therapy
6. Conclusions

Part IX. Post-Infectious Autoimmune Cardiac Diseases

Chapter 22. Rheumatic Fever and Rheumatic Heart Disease

1. Introduction
2. Clinical Presentation and Diagnostic Criteria
3. Pathophysiology
4. Treatment and Vaccine Perspective
5. Conclusions

Chapter 23. Chagas Cardiomyopathy

1. Introduction
2. Epidemiology
3. Etiology
4. Transmission
5. Diagnosis
6. Natural History and Pathogenesis
7. Infection in Immunosuppressed Patients
8. Chagas’ Heart Disease: Diagnosis and Treatment
9. Treatment of Chagas Cardiomyopathy
10. Conclusions

Part X. Autoinflammation

Chapter 24. Familial Mediterranean Fever

1. Introduction
2. Clinical Presentation and Diagnostic Criteria
3. Proposed Pathophysiology for Nonamyloidosis Cardiac Involvement in FMF
4. Cardiac Involvement in FMF
5. Treatment of FMF and Cardiac Implications of Therapy
6. Conclusions

Part XI. Therapeutic Approaches: Mechanisms of Action and Cardiac Effects

Chapter 25. Desirable and Adverse Effects of Antiinflammatory Agents on the Heart

1. Introduction
2. Nonsteroidal Antiinflammatory Drugs (NSAIDs)
3. Hydroxychloroquine
4. Methotrexate
5. Sulfasalazine
6. Minocycline
7. Varespladib
8. Leflunomide
9. Colchicine

Chapter 26. The Effects of Immunosuppressive and Cytotoxic Drugs on the Heart

1. Introduction
2. Glucocorticoids
3. Azathioprine
4. Methotrexate
5. Cyclosporine
6. Cyclophosphamide
7. Myocarditis
8. Conclusions and Future Directions

Chapter 27. Autoantibody-Directed Therapy in Cardiovascular Diseases

1. Introduction
2. Autoantibody Removal
3. Conclusion

Chapter 28. Cardiac Immunomodulation

1. Interleukin 1β-Signaling Pathway
2. Role of CD20 in Autoimmune Diseases
3. Involvement of IgE in Allergic Diseases
4. IL-6 Signaling
5. TNF-α and Its Receptors
6. Subunit p40 and Its Influence on Cytokine Regulation
7. Function of IL-17
8. Role of Phosphodiesterase 4 in Immune Cell Response
9. Involvement of Immunoglobulin CTLA-4 in T-Cell Activation
10. JAK-STAT Pathway
11. p38 Mitogen-Activated Protein Kinase
12. Alternative Immunomodulating Strategies
13. Future Perspectives

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The Heart in Rheumatic, Autoimmune and Inflammatory Diseases

Pathophysiology, Clinical Aspects and Therapeutic Approaches

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Empowering Progress

Institutional subscription on ScienceDirect

Udi Nussinovitch