Quentin Bodard1, Vincent Langlois2, Philippe Guilpain3, Alain Le Quellec3, Olivier Vittecoq4, David Noel5, Vincent Eble6, Séverine Josse7, Jean Schmidt8, Achille Aouba9, Hervé Levesque10, Maelle Le Besnerais10, Ygal Benhamou10. 1. Department of Internal Medicine, Infectious Diseases, Rheumatology and Endocrinology, Angoulême Hospital, 16959, Angoulême, France. 2. Department of Infectious Diseases and Internal Medicine, Le Havre Hospital, 76083, Le Havre, France. Electronic address: vincent.langlois@ch-havre.fr. 3. Department of Internal Medicine-Multiorganic Diseases, Saint-Eloi Hospital, IRMB, Univ Montpellier, INSERM, Montpellier University Hospital, 34295, Montpellier, France. 4. Department of Rheumatology, Rouen University Hospital, 76000, Rouen, France. 5. Department of Infectious Diseases and Internal Medicine, Elbeuf-Louviers Hospital, 76410, Elbeuf, France. 6. Department of Internal Medicine, Eure et Seine Hospital, 27015, Evreux, France. 7. Department of Internal Medicine, Dieppe Hospital, 76200, Dieppe, France. 8. Department of Internal Medicine, Amiens University Hospital, 80054, Amiens, France. 9. Department of Internal Medicine, Caen University Hospital, 14003, Caen, France. 10. Department of Internal Medicine, Rouen University Hospital, 76000, Rouen, France; INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen University Hospital, 76000, Rouen, France.
Abstract
OBJECTIVE: Adult-onset Still's disease (AOSD) is a rare inflammatory disease that may be life-threatening if complicated by cardiac problems. We performed a retrospective multicenter study to describe the manifestations, treatments and outcomes of cardiac involvement in AOSD. METHODS: We reviewed the medical databases of eight centers. All AOSD patients identified as fulfilling Yamagushi's or Fautrel's criteria were included in the study. Cardiac involvement, clinical manifestations, laboratory features, the course of the disease and treatments were evaluated. RESULTS: We included 96 AOSD patients in this study: 28 (29%) had documented cardiac involvement (AOSD + C group) and 68 (71%) had no cardiac involvement (control group). Cardiac complications were observed at diagnosis in 89% of cases. It were pericarditis (n = 17), tamponade (n = 5), myocarditis (n = 5) and non-infectious endocarditis (n = 1). Levels of leukocytes, neutrophils and C-reactive protein were significantly higher (p = 0.02, p = 0.02 and p = 0.002, respectively in the AOSD + C group than in the control group. Admission to intensive care, and the use of biotherapy were more frequent during follow-up in the AOSD + C group than the control group (p = 0.0001 and p = 0.03 respectively). Cardiac involvement was associated with refractory form in multivariate analyzed (p = 0.01). Corticosteroids were effective with or without methotrexate in 71% of patients but not in severe involvement as myocarditis or tamponade. CONCLUSION: Cardiac complications are frequent, inaugural, can be life-threatening and predictive of a refractory course in patients with AOSD. Systematic cardiac screening should be proposed at diagnosis and biotherapy early use should be considered especially in myocarditis.
OBJECTIVE: Adult-onset Still's disease (AOSD) is a rare inflammatory disease that may be life-threatening if complicated by cardiac problems. We performed a retrospective multicenter study to describe the manifestations, treatments and outcomes of cardiac involvement in AOSD. METHODS: We reviewed the medical databases of eight centers. All AOSD patients identified as fulfilling Yamagushi's or Fautrel's criteria were included in the study. Cardiac involvement, clinical manifestations, laboratory features, the course of the disease and treatments were evaluated. RESULTS: We included 96 AOSD patients in this study: 28 (29%) had documented cardiac involvement (AOSD + C group) and 68 (71%) had no cardiac involvement (control group). Cardiac complications were observed at diagnosis in 89% of cases. It were pericarditis (n = 17), tamponade (n = 5), myocarditis (n = 5) and non-infectious endocarditis (n = 1). Levels of leukocytes, neutrophils and C-reactive protein were significantly higher (p = 0.02, p = 0.02 and p = 0.002, respectively in the AOSD + C group than in the control group. Admission to intensive care, and the use of biotherapy were more frequent during follow-up in the AOSD + C group than the control group (p = 0.0001 and p = 0.03 respectively). Cardiac involvement was associated with refractory form in multivariate analyzed (p = 0.01). Corticosteroids were effective with or without methotrexate in 71% of patients but not in severe involvement as myocarditis or tamponade. CONCLUSION:Cardiac complications are frequent, inaugural, can be life-threatening and predictive of a refractory course in patients with AOSD. Systematic cardiac screening should be proposed at diagnosis and biotherapy early use should be considered especially in myocarditis.
Authors: Larissa Valor-Méndez; Bernhard Manger; Alexander Cavallaro; Stephan Achenbach; Georg Schett; Jürgen Rech Journal: Eur J Med Res Date: 2021-09-20 Impact factor: 2.175
Authors: Lilia M Sierra-Galan; Mona Bhatia; Angel Leovigildo Alberto-Delgado; Javier Madrazo-Shiordia; Carlos Salcido; Bernardo Santoyo; Eduardo Martinez; Maria Elena Soto Journal: Front Cardiovasc Med Date: 2022-07-13