Childhood rheumatic diseases: bites not only the joint, but also the heart

Abstract

Cardiovascular involvement in juvenile rheumatic diseases is the primary manifestation in paediatric vasculitis and a major organ manifestation in paediatric connective tissue diseases. Though coronary vasculitis is the prototypical manifestation of Kawasaki disease, it can also be seen in patients with polyarteritis nodosa. Pericarditis is the most common manifestation seen in juvenile rheumatic diseases like systemic onset JIA, and lupus. Cardiac tamponade, valvular insufficiency, aortic root dilatation and arrhythmias are seen rarely. Cardiac involvement is often recognized late in children. The development of cardiac disease in juvenile systemic sclerosis is associated with a poor outcome. In long term, childhood onset of rheumatic diseases predisposes to diastolic dysfunction and premature atherosclerosis during adulthood. Key Points • Pericarditis is the most common cardiac manifestation in SLE and can lead to tamponade. • Conduction defects are common in juvenile mixed connective tissue disease and systemic sclerosis. • Pulmonary hypertension is a significant contributor to mortality in juvenile systemic sclerosis. • In Kawasaki disease, early treatment can reduce risk of coronary artery aneurysms.

Expression of oxidative stress and inflammatory indicators for coronary artery disease in Kawasaki disease

“…Numerous long-term follow-up studies conducted both domestically and internationally have revealed that Kawasaki disease, particularly when accompanied by CAL, serves as a hazard factor for ischemic heart disease. 27 , 28 The progression of CAL in KD is attributed to the impaired function of coronary endothelial cells resulting from the interplay between inflammation and oxidative stress. 29 , 30 The current lack of specific laboratory indicators for early diagnosis of Kawasaki disease and Kawasaki disease CAL poses a challenge.…”