Pericarditis is a cardiac disease that commonly manifests with rheumatoid arthritis, and its complications are related to rheumatoid arthritis disease activity. The diagnosis can be complicated in patients with multiple extra-joint complications of rheumatoid arthritis. We report a case of pericarditis in an 82-year-old woman with few joint symptoms who was admitted to the hospital due to worsening edema of the lower legs and dyspnea, which progressed to cardiac tamponade. The patient presented with gradual onset of edema of both lower limbs and bilateral pleural effusion and was initially diagnosed with yellow nail syndrome. Ultimately, the patient was diagnosed with rheumatoid pericarditis due to a rapid increase in pericardial effusion. She was treated with non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine; however, the symptoms were progressive and required pericardiocentesis. After pericardiocentesis, the patient responded well to NSAIDs and colchicine, and systemic edema was relieved. This case highlights the fact that pericarditis associated with rheumatoid arthritis is not necessarily related to the severity of joint symptoms. Moreover, it can be difficult to differentiate pericarditis from multiple other diseases, such as yellow nail syndrome, in patients with rheumatoid arthritis who mainly have extra-articular symptoms.

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Pericarditis With Cardiac Tamponade Mimicking Yellow Nail Syndrome in a Patient With Rheumatoid Arthritis and a Paucity of Joint Symptoms

Rheumatoid Arthritis (RA) is among the most prevalent and impactful rheumatologic chronic autoimmune diseases (AIDs) worldwide. Within a framework that recognizes both immunological activation and inflammatory pathways, the exact cause of RA remains unclear. It seems however, that RA is initiated by a combination between genetic susceptibility, and environmental triggers, which result in an auto-perpetuating process. The subsequently, systemic inflammation associated with RA is linked with a variety of extra-articular comorbidities, including cardiovascular disease (CVD), resulting in increased mortality and morbidity. Hitherto, vast evidence demonstrated the key role of non-coding RNAs such as microRNAs (miRNAs) in RA, and in RA-CVD related complications. In this descriptive review, we aim to highlight the specific role of miRNAs in autoimmune processes, explicitly on their regulatory roles in the pathogenesis of RA, and its CV consequences, their main role as novel biomarkers, and their possible role as therapeutic targets.

/pdf/micrornas-mirnas-in-cardiovascular-complications-of-1lqiuifr.pdf

MicroRNAs (miRNAs) in Cardiovascular Complications of Rheumatoid Arthritis (RA): What Is New?

BACKGROUND
Rheumatoid arthritis (RA) is a systemic disease involving many organ systems and is frequently accompanied by cardiac alterations. However, there is considerable disagreement concerning the cardiac abnormalities found in patients with RA. The purpose of our investigation was to determine, by a non-invasive method such as echocardiography, the nature and extent of cardiac involvement in RA patients with no symptoms of cardiac disease, in comparison with a control sample.


METHODS
We selected 35 patients affected by rheumatoid arthritis (five men, 30 women), aged 51 +/- 11 years. No patient had either symptoms of cardiac disease or extra cardiac complaint. As a control group we studied 52 volunteers, aged 51 +/- 12 years, randomly selected among a larger group of subjects with no symptoms, signs and/or clinical findings of extra cardiac diseases. All were in sinus rhythm and without any cardiac symptom. Standard two-dimensional, M-mode and Doppler echocardiographic examination was carried out on each subject.


RESULTS
In RA patients we found a higher prevalence of several abnormalities. We found no statistically significant differences between the groups of RA patients based on the stage and duration of disease. We found no correlation between cardiac abnormalities and inflammatory indices or drug therapy.


DISCUSSION
At least three alterations seem to be typical of RA patients in the absence of any symptom of cardiac disease: (1) posterior pericardial effusion, (2) aortic root alterations and (3) valvular thickening. The prevalence of MVP is controversial and needs further investigation. These alterations are variously combined in each patient, and for this reason we think that it is possible to represent such a heart involvement as 'silent rheumatoid heart disease'. Moreover the knowledge of the presence of unrecognised cardiac abnormalities can be very important for the correct assessment and management of the RA patient.

Cardiac involvement in rheumatoid arthritis: evidence of silent heart disease


 
 To examine the risk of diabetes mellitus (DM) in patients with rheumatoid arthritis (RA) and whether the risk is related to conventional risk factors, RA disease activity, and treatment.
 
 
 
 A systematic literature review (SLR) query was conducted using specified MeSH terms, searching PubMed and EMBASE databases from inception to March 2020. Both cohort or case-control design studies assessing the incidence or prevalence of DM in RA patients were included.
 
 
 
 Of the 1948 articles, 43 peer-reviewed observational studies were selected. A high degree of heterogeneity in study design and reporting was observed, precluding final conclusions.
 Based on the studies included, it was observed that DM prevalence ranged between 1% and 20% in RA patients, which was similar to controls (1–29%). The cumulative incidence of DM in RA patients ranged between 1.3% and 11.7% over different time frames. DM incidence rates in patients with RA per 1000 person-years ranged from 5.2 to 16.7. 
 RA patients may be at higher risk of DM, particularly among those receiving glucocorticoids (GC), while patients on hydroxychloroquine and biological disease-modifying anti-rheumatic treatments (DMARDs) may be at lower risk.
 
 
 
 DM incidence may be increased in patients with RA as a result of more concomitant traditional risk factors and GC exposure. It is unclear whether biologics may have a true protective effect or provide a GC-sparing effect. High-quality studies in large cohorts of RA patients with appropriate adjustment for covariates are warranted to fully investigate the interplay between DM and RA.


Association between Diabetes and Rheumatoid Arthritis: A Systematic Literature Review

The clinical spectrum of SARS-CoV-2 infection continues to expand, raising important fundamental issues regarding the SARS-CoV-2 cellular tropism and pathogenic mechanisms. Liver damage is observed in patients with all forms of COVID-19, especially severe and critical forms, which could be due to the direct viral damage, immune dysregulation (systemic inflammatory response and cytokine storm), hypoxia-ischemia, drug-induced hepatotoxicity, and concomitant chronic disorders. Liver damage, defined primarily by elevated transaminase levels, is often observed in patients with COVID-19 and correlates with clinical outcomes, including mortality. Diagnostic criteria, pathogenesis, clinical characteristics, treatment, and prognosis of liver injury in COVID-19 should be clarified in further clinical trials. Currently, there is a critical shortage of proven treatment options for patients with COVID-19, resulting in an urgent need to study the multiple organ failure and liver damage pathogenesis in patients with this disease. The review provides information about the pathophysiological mechanisms of the SARS-CoV-2-induced liver damage and the development of liver failure in COVID-19. Information sources were searched in the PubMed database using the keywords “liver damage in COVID-19” and “immune liver damage in COVID-19”.

Liver damage in patients with COVID-19

Introduction Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic autoimmune disease. The increased inflammatory burden in RA may result in atherosclerosis, myocardial infarction (MI), and subsequent mortality. In this study, we will determine the frequency of cardiovascular manifestation in RA patients through history, laboratory workup, and echocardiography. Methods This cross-sectional study was conducted in the rheumatology unit of a tertiary care hospital in Pakistan. Three hundred and twenty-two (n=322) participants with a previously confirmed diagnosis of RA were enrolled in this study via consecutive convenient non-probability sampling. Results Cardiovascular manifestations were present in 188 (58.3%) participants. More participants had positive rheumatoid factor (82.9% vs. 32.8%; p-value: < 0.0001) in RA patients with cardiovascular manifestation compared to RA patients without cardiovascular manifestation. Patients with cardiovascular manifestations have a significantly higher C-reactive protein (CRP; 10.21 ± 2.81 mg/L vs. 8.17± 2.01 mg/L; p value: < 0.0001) and erythrocyte sedimentation rate (ESR; 16.2 ± 3.14 mg/L vs. 15.1 ± 2.99 mg/L; p value: 0.0017). Conclusion In this study, patients with a cardiovascular manifestation had a higher frequency of patients with rheumatoid factor, higher mean values of CRP and ESR. The early diagnosis and management of cardiac manifestations would aid in controlling the severity of the disease and the overall mortality.

Frequency of Cardiovascular Manifestation in Patients With Rheumatoid Arthritis.

Introduction Coronavirus disease 2019 (COVID-19) affects various organs including lungs, brain, and eyes. Very limited data is available related to the effect of COVID-19 on liver. This study is conducted to determine the impact of COVID-10 on liver by measuring the frequency of participants with deranged liver enzymes in patients diagnosed with COVID-19. Methods This cross-sectional study was conducted in a COVID-19 unit of a tertiary care hospital in Pakistan from February 2021 to June 2021. A total of 900 patients admitted with COVID-19 were enrolled in the study after seeking informed consent. After enrollment, taking history and vitals, 5 mL blood was drawn via phlebotomy and sent to the laboratory to test for C-reactive protein, lactate dehydrogenase, and liver enzymes. Results Overall 141 (28.2%) participants had a minimum of one deranged liver enzyme. The most commonly deranged liver enzyme found was alanine transaminase (ALT), both in males (19.9%) and females (21.3%), followed by aspartate transaminase (male: 18.3% and female: 20.3%). Serum total bilirubin was deranged in both males (8.4%) and females (8.3%). There was no significant difference in the gender-wise prevalence of deranged liver enzymes.  Conclusion Liver enzymes are frequently deranged in patients admitted with COVID-19. Liver enzymes should be regularly monitored during the course of management of COVID-19, as various medications used in the treatment of COVID-19 may further deteriorate liver enzymes and may cause long-term damage.

Impact of Coronavirus Diseases on Liver Enzymes.

Introduction Hypertension is a very common risk factor for erectile dysfunction (ED). In recent time, changes in lifestyle has led to an increase in the prevalence of hypertension, which has increased the risk of ED. The purpose of this study is to assess the prevalence of ED in hypertensive patients and compare various domains of sexual activity between hypertensive and normotensive participants. Methods This case-control study was conducted in an outpatient department of a tertiary health care hospital in Pakistan from March 2019 to September 2019. Two hundred and twelve clinically diagnosed hypertensive patients were enrolled and were identified as case group. Control group consisted of 212 people, without any history of hypertension. Sexual function was assessed with the International Index of Erectile Function (IIEF). Results The prevalence of erectile dysfunction in hypertensive group was 61.79%, compared to 20.28% in normotensive group. Erectile weakness (OR = 4.32, CI 2.64-7.05), impaired morning erection (OR = 5.02, CI 2.98-8.47), complete erectile failure (OR = 2.32, CI 1.14-4.75), impaired spontaneous erection (OR = 5.45, CI 3.28-9.03), ejaculatory disturbances (OR = 5.20, CI 2.96-9.12) and reduced sexual interest (OR = 5.12, CI 3.04-8.64) were found to be significantly higher in patients with hypertension compared to normotensive participants. Conclusion This study has found ED to be prevalent in hypertensive patients. Identifying and acknowledging hypertension as a risk factor may help identify patients with ED and reinforce the clinician's importance of asking sexual history of hypertensive patients.

Manoj Kumar Khamuani

Papers

Frequency of Cardiovascular Manifestation in Patients With Rheumatoid Arthritis.

Impact of Coronavirus Diseases on Liver Enzymes.

Comparison of the Prevalence of Erectile Dysfunction Between Hypertensive and Normotensive Participants: A Case-Control Study.