Cardiac rheumatoid nodules

Ojeda, Victor J.; Stuckey, Bronwyn; Owen, E. T.; Walters, M. N‐I.

doi:10.5694/j.1326-5377.1986.tb113669.x

Cited by 13 publications

(8 citation statements)

References 4 publications

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“…In a series using transesophageal echocardiography [47], however, thirteen percent of RA patients were found to have clinically silent pericarditis versus zero percent of non-RA controls. Case reports of rheumatoid nodules [73,74], restrictive pericarditis [75,76], and coronary vasculitis [77] in RA patients resulting in CHF are not uncommon in the literature, although it is likely that these entities account for only a small portion of the excess cases of CHF in RA.…”

Section: Risk Factors Echocardiographic Predictors and Biochemical mentioning

confidence: 99%

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et al. 2005

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ATTACH = Anti-TNF-α Therapy Against Chronic Heart failure; CHF = congestive heart failure; CVD = cardiovascular disease; IL = interleukin; LV = left ventricular; LVEF = left ventricular ejection fraction; MI = myocardial infarction; MMP = matrix metalloproteinase; OA = osteoarthritis; RA = rheumatoid arthritis; RECOVER = Research into Etanercept: Cytokine Antagonism in Ventricular Dysfunction Trial; RENNAISANCE = Randomized Etanercept North American Strategy to Study Antagonism of Cytokines; RF rheumatoid factor; TACE = TNF-α converting enzyme; TIMP = tissue inhibitor of matrix metalloproteinase; TNF-α = tumor necrosis factor-α.Available online http://arthritis-research.com/content/7/5/195 AbstractData from population-and clinic-based epidemiologic studies of rheumatoid arthritis patients suggest that individuals with rheumatoid arthritis are at risk for developing clinically evident congestive heart failure. Many established risk factors for congestive heart failure are over-represented in rheumatoid arthritis and likely account for some of the increased risk observed. In particular, data from animal models of cytokine-induced congestive heart failure have implicated the same inflammatory cytokines produced in abundance by rheumatoid synovium as the driving force behind maladaptive processes in the myocardium leading to congestive heart failure. At present, however, the direct effects of inflammatory cytokines (and rheumatoid arthritis therapies) on the myocardia of rheumatoid arthritis patients are incompletely understood. IntroductionUnique cardiac complications of rheumatoid arthritis (RA), such as cardiac rheumatoid nodules, have been recognized for over a century. It has only been appreciated in the last decades, however, that certain chronic autoimmune inflammatory diseases, such as RA and systemic lupus erythematosis, increase the risk of developing cardiovascular disease (CVD), particularly atherosclerosis and congestive heart failure (CHF) [1][2][3][4][5]. In fact, striking commonalities in the cellular and cytokine profiles of the rheumatoid synovial lesion and atherosclerotic plaque [6][7][8] have prompted speculation that the inflammatory pathways of RA may initiate and/or accelerate plaque formation and that this effect may be ameliorated by anti-inflammatory therapies [9].The link between RA and CHF is less well studied. The CHF phenotype can evolve from a variety of pathogenic conditions, many of which may be promoted by the RA disease process. Yet to date, only a handful of investigations have attempted to dissect this complex issue. A particular source of confusion has been the apparent contradiction between pre-clinical studies linking inflammation to CHF and the lack of efficacy of anti-cytokine therapy in clinical trials in advanced CHF (discussed below). Because anti-cytokine therapy has become a cornerstone in the treatment of RA, it is particularly critical to understand the contribution of cytokine-induced inflammation to myocardial structure and function in RA. Here, we review the curre...

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Section: Risk Factors Echocardiographic Predictors and Biochemical mentioning

confidence: 99%

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et al. 2005

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“…Two other cases were also described but both expired within weeks after presentation. In both reports, associated cardiac pathology was present; specifically, recurrent pericardial effusion in one case and intracardiac nodules in the other 12 13. Microscopically, rheumatoid nodules have a centre of fibrinoid necrosis surrounded by a prominent rim of epithelioid histiocytes, and numerous lymphocytes and plasma cells 14.…”

Section: Discussionmentioning

confidence: 91%

Pericardial mass in a patient with rheumatoid arthritis

et al. 2015

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A 65-year-old man presented with long-standing rheumatoid arthritis (RA), severe fatigue and mild arthritis of metacarpophalaneal joints. Physical examination revealed S3, II/IV decrescendo diastolic murmur and 2+ LL oedema. Anticyclic citrullinated peptide antibodies were >250 units. Echocardiogram showed an 8 cm pericardial mass with no atrial or ventricular collapse and mild to moderate aortic regurgitation. Cardiac MRI defined the mass as a heterogeneous entity attached to the right, anterior and inferior heart borders, with compression on right cardiac structures and the left ventricle. CT-guided biopsy demonstrated fibrinous material without granulomas or infection. Fatigue did not improve on immunosuppression with low-dose prednisone and leflunamide. Cardiac tamponade was confirmed by heart catheterisation and the mass was surgically excised with partial pericardiectomy. The patient had a dramatic improvement and, 4 years later, he remains asymptomatic cardiac wise. This case highlights the clinical significance of pericardial disease in RA and its response to therapy.

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“…The histological findings include a central zone of necrotic connective tissue surrounded by histiocytes, fibroblasts, and multinucleated giant cells. The outer layer of the inflammatory infiltrate consists of lymphocytes, histiocytes, plasma cells, and polymorphonuclear neutrophils [5] [6].…”

Section: Discussionmentioning

confidence: 99%

Rheumatoid Nodule Causing Perforation of Anterior Mitral Leaflet and Severe Mitral Regurgitation: A Rare Case Report

Koneru¹,

Cholankeril²,

Shah³

et al. 2014

WJCD

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Rheumatoid arthritis (RA) is a systemic disorder that is chronic in nature and difficult to treat. RA presents in many variants. Here we present an interesting case only seldom described before. Our patient presented to emergency room with acute shortness of breath and was seen to have acute pulmonary edema. Patient later had urgent echocardiography which revealed severe mitral regurgitation from ruptured anterior leaflet. Patient was taken for heart valve replacement and was found to have RA nodule on ruptured leaflet. There are cases involving aortic valve but to our knowledge there are no reports of RA nodule on mitral leaflet.

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Cardiac rheumatoid nodules

Cited by 13 publications

References 4 publications

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Pericardial mass in a patient with rheumatoid arthritis

Rheumatoid Nodule Causing Perforation of Anterior Mitral Leaflet and Severe Mitral Regurgitation: A Rare Case Report

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