Cardiovascular Rheumatic Diseases
Preface
Richard D. Brasington Jr, MD Editor
When I was in medical school, I remember arguing with a classmate about whether the brain or the heart should be considered the more important organ. My classmate declared, “The Heart is just a pump to supply the Brain with blood, so the Brain is more important.” I countered that without the Heart, the Brain was dead, so I felt that I had won the argument. Our understanding of The Heart in the Rheumatic Diseases has become much more sophisticated since my fellowship during the 1980s. Although we were then beginning to realize that the life expectancy of severe rheumatoid arthritis (RA) was similar to that of three-vessel coronary artery disease, we did not yet understand that the RA itself was a significant risk factor for coronary disease. Furthermore, during the last decade, we learned that rather than protecting against coronary disease, nonsteroidal drugs may have an adverse effect on coronary disease. In this volume, we have gathered experts in their respective fields to review the most recent literature to help us more fully understand how the heart can be involved in the major rheumatologic disorders. Since the heart is itself a muscle, we begin with the inflammatory myopathies, in which Van Gelder and Charles-Schoeman focuses on myocarditis and cardiomyopathies. Unizony and Miloslavsky follow with a thorough inventory of cardiac involvement in the systemic vasculitides. Sen and Gonzalez-Mayda bring us up to date on our current understanding of the heart in RA: not only coronary disease, but pericarditis, valvular heart disease, and the myocardial effects of medications used to treat RA. Baszis and colleagues address pediatric rheumatic diseases, covering juvenile arthritis and dermatomyositis, acute rheumatic fever, and Kawasaki disease. The multiple cardiac manifestations of lupus are covered by Miner and Kim, who concentrate on neonatal lupus, pericarditis, myocarditis, and the very complex issue of premature coronary artery disease in lupus patients. The scleroderma section by Parks and colleagues is followed by a thorough treatment of pulmonary artery hypertension by Ahmed and Palevsky, emphasizing the fact that pulmonary hypertension is the leading cause of death in scleroderma. These articles discuss the most current methods for detecting and following pulmonary hypertension, a rapidly evolving field.
Rheum Dis Clin N Am 40 (2014) xi–xii http://dx.doi.org/10.1016/j.rdc.2013.10.009 0889-857X/14/$ – see front matter Ó 2014 Published by Elsevier Inc.
rheumatic.theclinics.com
xii
Preface
We conclude with gout, a condition for which rheumatologists are much more focused on the joints than the myocardium. Krishnan reminds us that there is much more to gout than just arthritis. Our goal has been to gather together in one volume the state of the art of what is known about the heart in the rheumatic diseases in 2014. We hope that this will be of value to students at all levels, as well as practitioners of rheumatology. Richard D. Brasington Jr, MD Division of Rheumatology Washington University in St Louis 156 Gray Avenue St Louis, MO 63119-2914, USA E-mail address: [email protected]
Preface
Richard D. Brasington Jr, MD Editor
When I was in medical school, I remember arguing with a classmate about whether the brain or the heart should be considered the more important organ. My classmate declared, “The Heart is just a pump to supply the Brain with blood, so the Brain is more important.” I countered that without the Heart, the Brain was dead, so I felt that I had won the argument. Our understanding of The Heart in the Rheumatic Diseases has become much more sophisticated since my fellowship during the 1980s. Although we were then beginning to realize that the life expectancy of severe rheumatoid arthritis (RA) was similar to that of three-vessel coronary artery disease, we did not yet understand that the RA itself was a significant risk factor for coronary disease. Furthermore, during the last decade, we learned that rather than protecting against coronary disease, nonsteroidal drugs may have an adverse effect on coronary disease. In this volume, we have gathered experts in their respective fields to review the most recent literature to help us more fully understand how the heart can be involved in the major rheumatologic disorders. Since the heart is itself a muscle, we begin with the inflammatory myopathies, in which Van Gelder and Charles-Schoeman focuses on myocarditis and cardiomyopathies. Unizony and Miloslavsky follow with a thorough inventory of cardiac involvement in the systemic vasculitides. Sen and Gonzalez-Mayda bring us up to date on our current understanding of the heart in RA: not only coronary disease, but pericarditis, valvular heart disease, and the myocardial effects of medications used to treat RA. Baszis and colleagues address pediatric rheumatic diseases, covering juvenile arthritis and dermatomyositis, acute rheumatic fever, and Kawasaki disease. The multiple cardiac manifestations of lupus are covered by Miner and Kim, who concentrate on neonatal lupus, pericarditis, myocarditis, and the very complex issue of premature coronary artery disease in lupus patients. The scleroderma section by Parks and colleagues is followed by a thorough treatment of pulmonary artery hypertension by Ahmed and Palevsky, emphasizing the fact that pulmonary hypertension is the leading cause of death in scleroderma. These articles discuss the most current methods for detecting and following pulmonary hypertension, a rapidly evolving field.
Rheum Dis Clin N Am 40 (2014) xi–xii http://dx.doi.org/10.1016/j.rdc.2013.10.009 0889-857X/14/$ – see front matter Ó 2014 Published by Elsevier Inc.
rheumatic.theclinics.com
xii
Preface
We conclude with gout, a condition for which rheumatologists are much more focused on the joints than the myocardium. Krishnan reminds us that there is much more to gout than just arthritis. Our goal has been to gather together in one volume the state of the art of what is known about the heart in the rheumatic diseases in 2014. We hope that this will be of value to students at all levels, as well as practitioners of rheumatology. Richard D. Brasington Jr, MD Division of Rheumatology Washington University in St Louis 156 Gray Avenue St Louis, MO 63119-2914, USA E-mail address: [email protected]
