Información del artículo
Resumen
Las enfermedades reumáticas autoinmunes son trastornos inflamatorios que pueden afectar a múltiples órganos, entre los que se incluye el corazón. El elevado riesgo de aparición de patología cardiovascular en estos pacientes no solo se debe a la presencia de factores de riesgo cardiovascular tradicionales, sino también a la inflamación crónica y la autoinmunidad. Todas las estructuras cardíacas pueden verse afectadas durante el curso de la enfermedad (válvulas, sistema de conducción, miocardio, endocardio, pericardio y arterias coronarias), por lo que las complicaciones cardíacas incluyen una amplia variedad de manifestaciones clínicas. La afectación cardíaca se asocia con un pronóstico desfavorable, por lo que es esencial detectar la lesión cardíaca subclínica en pacientes asintomáticos e instaurar el tratamiento de forma precoz. Este documento ofrece una revisión actualizada de las principales manifestaciones cardíacas de las enfermedades reumáticas, así como su manejo terapéutico.
Palabras clave:
Enfermedades reumáticas
Enfermedades autoinmunitarias
Cardiopatía
Abstract
Autoimmune rheumatic diseases are inflammatory disorders that can involve multiple organs, including the heart. The high risk of cardiovascular pathology in these patients is not only due to traditional cardiovascular risk factors, but also to chronic inflammation and autoimmunity. All cardiac structures may be affected during the course of systemic autoimmune diseases (valves, the conduction system, the myocardium, endocardium and pericardium, and coronary arteries), and the cardiac complications have a variety of clinical manifestations. As these are all associated with an unfavourable prognosis, it is essential to detect subclinical cardiac involvement in asymptomatic systemic autoimmune disease patients and begin adequate management and treatment early. In this review, we examine the multiple cardiovascular manifestations in patients with rheumatological disorders and available management strategies.
Keywords:
Rheumatic diseases
Autoimmune diseases
Cardiac disease
Artículo
Opciones para acceder a los textos completos de la publicación Medicina Clínica
Suscriptor
Comprar
Contactar
Teléfono para suscripciones e incidencias
De lunes a viernes de 9h a 18h (GMT+1) excepto los meses de julio y agosto que será de 9 a 15h
Llamadas desde España
932 415 960
Llamadas desde fuera de España
+34 932 415 960
E-mail
Bibliografía
[1]
G. Kitas, M.J. Banks, P.A. Bacon.
Cardiac involvement in rheumatoid disease.
Clin Med., 1 (2001), pp. 18-21
[2]
D. Seoane-Mato, C. Sánchez-Piedra, F. Díaz-González, S. Bustabad.
Prevalence of rheumatic diseases in adult population in Spain. Episer 2016 study.
Ann Rheum Dis., 77 (2018), pp. 535
[3]
M.J.L. Peters, D.P.M. Symmons, D. McCarey, B.A.C. Dijkmans, P. Nicola, T.K. Kvien, et al.
EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis.
Rheum Dis., 69 (2010), pp. 325-331
[4]
A. Escalante, R.L. Kaufman, F.P. Quismorio Jr., T.D. Beardmore.
Cardiac compression in rheumatoid pericarditis.
Semin Arthritis Rheum., 20 (1990), pp. 148-163
[5]
D. Sen, M. González-Mayda, R.D. Brasington Jr..
Cardiovascular disease in rheumatoid arthritis.
Rheum Dis Clin North Am., 40 (2014), pp. 27-49
[6]
L. Theander, B.M. Nyhäll-Wåhlin, J.A. Nilsson, M. Willim, L.T.H. Jacobsson, I.F. Petersson, et al.
Severe extraarticular manifestations in a community-based cohort of patients with rheumatoid arthritis: Risk factors and incidence in relation to treatment with tumor necrosis factor inhibitors.
J Rheumatol., 44 (2017), pp. 981-987
[7]
C. Guedes, P. Bianchi-Fior, B. Cormier, B. Barthelemy, A.C. Rat, M.C. Boissier, et al.
Cardiac manifestations of rheumatoid arthritis: A case-control transesophageal echocardiography study in 30 patients.
Arthritis Rheum., 45 (2001), pp. 129-135
[8]
P.J. Nicola, H. Maradit-Kremers, V.L. Roger, S.J. Jacobsen, C.S. Crowson, K.V. Ballman, et al.
The risk of congestive heart failure in rheumatoid arthritis: A population-based study over 46 years.
Arthritis Rheum., 52 (2005), pp. 412-420
[9]
M.B. Owlia, S.M. Mostafavi Pour Manshadi, N. Naderi.
Cardiac manifestations of rheumatological conditions: A narrative review.
ISRN Rheumatol., 2012 (2012), pp. 463620
[10]
G. Cioffi, O. Viapiana, F. Ognibeni, A. Dalbeni, D. Gatti, C. Mazzone, et al.
Combined circumferential and longitudinal left ventricular systolic dysfunction in patients with rheumatoid arthritis without overt cardiac disease.
J Am Soc Echocardiogr., 29 (2016), pp. 689-698
[11]
N. Costedoat-Chalumeau, J.S. Hulot, Z. Amoura, A. Delcourt, T. Maisonobe, R. Dorent, et al.
Cardiomyopathy related to antimalarial therapy with illustrative case report.
Cardiology., 107 (2007), pp. 73-80
[12]
J.E. Nord, P.K. Shah, R.Z. Rinaldi, M.H. Weisman.
Hydroxychloroquine cardiotoxicity in systemic lupus erythematosus: A report of 2 cases and review of the literature.
Semin Arthritis Rheum., 33 (2004), pp. 336-351
[13]
P. Muthukrishnan, H. Roukoz, G. Grafton, J. Jessurun, M. Colvin-Adams.
Hydroxychloroquine-induced cardiomyopathy: A case report.
Circ Heart Fail., 4 (2011), pp. e7-e8
[14]
D.L. Mann, J.J. McMurray, M. Packer, K. Swedberg, J.S. Borer, W.S. Colucci, et al.
Targeted anticytokine therapy in patients with chronic heart failure: results of the Randomized Etanercept World-wide Evaluation (RENEWAL).
Circulation., 109 (2004), pp. 1594-1602
[15]
E.S. Chung, M. Packer, K.H. Lo, A.A. Fasanmade, J.T. Willerson, Anti-TNF Therapy Against Congestive Heart Failure Investigators.
Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: Results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial.
Circulation, 107 (2003), pp. 3133-3140
[16]
C. Barnabe, B. Martin, W. Ghali.
Systematic review and meta-analysis: Anti-tumor necrosis factor a therapy and cardiovascular events in rheumatoid arthritis.
Arthritis Care Res., 4 (2011), pp. 522-529
[17]
S. Van Doornum, G. McColl, I.P. Wicks.
Accelerated atherosclerosis: An extraarticular feature of rheumatoid arthritis?.
Arthritis Rheum., 46 (2002), pp. 862-873
[18]
Y. Shoenfeld, R. Gerli, A. Doria, E. Matsuura, M.M. Cerinic, N. Ronda, et al.
Accelerated atherosclerosis in autoimmune rheumatic diseases.
Circulation., 112 (2005), pp. 3337-3347
[19]
I.D. Del Rincón, K. Williams, M.P. Stern, G.L. Freeman, A. Escalante.
High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors.
Arthritis Rheum., 44 (2001), pp. 2737-2745
[20]
M.A. Gonzalez-Gay, C. Gonzalez-Juanatey, M.J. Lopez-Diaz, A. Piñeiro, C. Garcia-Porrua, J.A. Miranda-Filloy, et al.
HLA-DRB1 and persistent chronic inflammation contribute to cardiovascular events and cardiovascular mortality in patients with rheumatoid arthritis.
Arthritis Rheum., 57 (2007), pp. 125-132
[21]
E. Krishnan, V.B. Lingala, G. Singh.
Declines in mortality from acute myocardial infarction in successive incidence and birth cohorts of patients with rheumatoid arthritis.
Circulation., 110 (2004), pp. 1774-1779
[22]
D. Krause, B. Schleusser, G. Herborn, R. Rau.
Response to methotrexate treatment is associated with reduced mortality in patients with severe rheumatoid arthritis.
Arthritis Rheum., 43 (2000), pp. 14-21
[23]
L. Carmona, M.A. Descalzo, E. Perez-Pampin, D. Ruiz-Montesinos, A. Erra, T. Cobo, et al.
All-cause and cause-specific mortality in rheumatoid arthritis are not greater than expected when treated with tumour necrosis factor antagonists.
Ann Rheum Dis., 66 (2007), pp. 880-885
[24]
P.E. Lazzerini, P.L. Capecchi, M. Acampa, M. Galeazzi, F. Laghi-Pasini.
Arrhythmic risk in rheumatoid arthritis: The driving role of systemic inflammation.
Autoimmun Rev., 13 (2014), pp. 936-944
[25]
K.G. Moder, T.D. Miller, H.D. Tazelaar.
Cardiac involvement in systemic lupus erythematosus.
May Clin Proc., 74 (1999), pp. 275-284
[26]
A. Villa-Forte, B.F. Mandell.
Cardiovascular disorders and rheumatic disease.
Rev Esp Cardiol., 64 (2011), pp. 809-817
[27]
J.J. Miner, A.H.J. Kim.
Cardiac manifestations of systemic lupus erythematosus.
Rheum Dis Clin North Am., 40 (2014), pp. 51-60
[28]
I.G. Crozier, E. Li, M.J. Milne, M.G. Nicholls.
Cardiac involvement in systemic lupus erythematosus detected by echocardiography.
Am J Cardiol., 65 (1990), pp. 1145-1148
[29]
K.S. Hara, D.J. Ballard, D.M. Ilstrup, D.C. Connolly, R.S. Vollertsen.
Rheumatoid pericarditis: Clinical features and survival.
Medicine (Baltimore)., 69 (1990), pp. 81-91
[30]
K. Tselios, M.B. Urowitz.
Cardiovascular and pulmonary manifestations of systemic lupus erythematosus.
Curr Rheumatol Rev., 13 (2017), pp. 206-218
[31]
A. Zapata-Cárdenas, L.F. Pinto Peñaranda, C. Saldarriaga Giraldo, C.J. Velásquez Franco, J.D. Márquez Hernández.
El corazón en lupus eritematoso sistémico: revisión estructurada de la literatura.
Rev Colomb Reumatol., 20 (2013), pp. 148-154
[32]
M. Prasad, J. Hermann, S.E. Gabriel, C.M. Weyand, C. Mulvagh, R. Mankad, et al.
Cardiorheumatology: Cardiac involvement in systemic rheumatic disease.
Nat Rev Cardiol., 12 (2015), pp. 168-176
[33]
J.S. Bert, M. Abdullah, T.G. Dahle, E. Gertner.
Transcatheter aortic valve replacement for advanced valvular disease in active SLE and APS.
Lupus., 22 (2013), pp. 1046-1049
[34]
J. Tanwani, K. Tselios, D.D. Gladman, J. Su, M.B. Urowitz.
Lupus myocarditis: A single center experience and a comparative analysis of observational cohort studies.
Lupus., 27 (2018), pp. 1296-1302
[35]
M.J. Roman, J.E. Salmon.
Cardiovascular manifestations of rheumatologic diseases.
Circulation., 116 (2007), pp. 2346-2355
[36]
P. Sarzi-Puttini, F. Atzeni, R. Gerli, E. Bartoloni, A. Doria, T. Barskova, et al.
Cardiac involvement in systemic rheumatic diseases: An update.
Autoimmun Rev., 9 (2010), pp. 849-852
[37]
P.M. Seferović, A.D. Ristić, R. Maksimović, D.S. Simeunović, G.G. Ristić, G. Radovanović, et al.
Cardiac arrhythmias and conduction disturbances in autoimmune rheumatic diseases.
Rheumatology (Oxford)., 45 (2006), pp. iv39-iv42
[38]
F.J. Muñoz-Rodríguez, J.C. Reverter Calatayud, J. Font Franco, G. Espinosa Garriga, D. Tàssies Penella, M. Ingelmo Morin.
Cardiopatía valvular en pacientes con síndrome antifosfolípido.
Rev Clin Esp., 202 (2002), pp. 529-533
[39]
D. George, D. Erkan.
Antiphospholipid syndrome.
Prog Cardiovasc Dis., 52 (2009), pp. 115-125
[40]
A. Tufano, M.N.D. Di Minno, A. Guida, M. Lembo, G. Di Minno, M. Galderisi.
Cardiac manifestations of antiphospholipid syndrome: Clinical presentation role of cardiac imaging, and treatment strategies.
Semin Thromb Hemost., 45 (2019), pp. 468-477
[41]
T. Kolitz, S. Shiber, I. Sharabi, A. Winder, G. Zandman-Goddard.
Cardiac manifestations of antiphospholipid syndrome with focus on its primary form.
Front. Immunol., 10 (2019), pp. 941
[42]
G. Denas, S.P. Jose, A. Bracco, G. Zoppellaro, V. Pengo.
Antiphospholipid syndrome and the heart: A case series and literature review.
Autoimmun Rev., 14 (2015), pp. 214-222
[43]
J. Pardos-Gea, G. Avegliano, A. Evangelista, M. Vilardell, J. Ordi-Ros.
Cardiac manifestations other than valvulopathy in antiphospholipid syndrome: Long-time echocardiography follow-up study.
Int J Rheum Dis., 18 (2015), pp. 76-83
[44]
J.P.A. Ioannidis, P.G. Vlachoyiannopoulos, A.B. Haidich, T.A. Medsger Jr., M. Lucas, C.J. Michet, et al.
Mortality in systemic sclerosis: An international meta-analysis of individual patient data.
Am J Med., 118 (2005), pp. 2-10
[45]
L.Y. Nie, X.D. Wang, T. Zhang, J. Xue.
Cardiac complications in systemic sclerosis: Early diagnosis and treatment.
Chin Med J (Engl)., 132 (2019), pp. 2865-2871
[46]
M. Colaci, C. Schinocca, Y. dal Bosco, G. Ronsivalle, G. Guggino, I. de Andres, et al.
Heart valve abnormalities in systemic sclerosis patients: A multicenter cohort study and review of the literature.
J Clin Rheumatol., (2020),
[47]
K. Au, M.K. Singh, V. Bodukam, S. Bae, P. Maranian, R. Ogawa, et al.
Atherosclerosis in systemic sclerosis: A systematic review and meta-analysis.
Arthritis Rheum., 63 (2011), pp. 2078-2090
[48]
H.C. Champion.
The heart in scleroderma.
Rheum Dis Clin North Am., 34 (2008), pp. 181-188
[49]
F. Buleu, E. Sirbu, A. Caraba, S. Dragan.
Heart involvement in inflammatory rheumatic diseases: A systematic literature review.
Medicina (Kaunas)., 55 (2019), pp. 249
[50]
A. Grimaldi, L. de Gennaro, A. Chiara Vermi, F. Pappalardo, N. Daniele Brunetti, M. di Biase, et al.
Cardiac valve involvement in systemic diseases: A review.
Clin Cardiol., 36 (2013), pp. 117-124
[51]
E. Galve, J. Ordi, J. Candell, J. Soler Soler.
Enfermedades del tejido conectivo y corazón.
Rev Esp Cardiol., 51 (1998), pp. 232-242
[52]
C. Pagnoux, R. Seror, C. Henegar, A. Mahr, P. Cohen, V. le Guern, 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 Rheum., 62 (2010), pp. 616-626
[53]
E. Miloslavsky, S. Unizony.
The heart in vasculitis.
Rheum Dis Clin North Am., 40 (2014), pp. 11-26
[54]
C. Comarmond, C. Pagnoux, M. Khellaf, J.F. Cordier, M. Hamidou, J.F. Viallard, et al.
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): Clinical characteristics and long-term followup of the 383 patients enrolled in the French Vasculitis Study Group cohort.
Arthritis Rheum., 65 (2013), pp. 270-281
[55]
R.M. Dennert, P. van Paassen, S. Schalla, T. Kuznetsova, B.S. Alzand, J.A. Staessen, et al.
Cardiac involvement in Churg-Strauss syndrome.
Arthritis Rheum., 62 (2010), pp. 627-634
[56]
M. Ando, Y. Kosakai, Y. Okita, K. Nakano, S. Kitamura.
Surgical treatment for aortic regurgitation caused by Takayasu's arteritis.
J Card Surg., 13 (1998), pp. 202-207
[57]
C.E. Fields, T.C. Bower, L.T. Cooper, T. Hoskin, A.A. Noel, J.M. Panneton, et al.
Takayasu's arteritis: Operative results and influence of disease activity.
J Vasc Surg., 43 (2006), pp. 64-71
[58]
M.C. Park, S.W. Lee, Y.B. Park, S.K. Lee, D. Choi, W.H. Shim.
Post-interventional immunosuppressive treatment and vascular restenosis in Takayasu's arteritis.
Rheumatology (Oxford)., 45 (2006), pp. 600-605
[59]
P. Korantzopoulos, D. Papaioannides, K. Siogas.
The heart in Wegener's granulomatosis.
Cardiology., 102 (2004), pp. 7-10
[60]
A.L.P. Caforio, Y. Adler, C. Agostini, Y. Allanore, A. Anastasakis, M. Arad, et al.
Diagnosis and management of myocardial involvement in systemic immunmediated diseases: A position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Disease.
Eur Heart J., 38 (2017), pp. 2649-2662
