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

Koshy Nithin Thomas1, Amita Aggarwal2

  • 1Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.

Clinical Rheumatology
|May 9, 2023
PubMed

Insights

Juvenile rheumatic diseases frequently affect the heart, with pericarditis being common in lupus and JIA. Early recognition and treatment are crucial for managing cardiac complications and improving long-term outcomes in children.

Area of Science:

  • Pediatric Rheumatology
  • Cardiology
  • Immunology

Background:

  • Cardiovascular involvement is a primary manifestation in pediatric vasculitis and a significant organ manifestation in pediatric connective tissue diseases.
  • While coronary vasculitis is characteristic of Kawasaki disease, it can also occur in polyarteritis nodosa.
  • Pericarditis is the most frequent cardiac manifestation in juvenile rheumatic diseases such as systemic onset juvenile idiopathic arthritis (JIA) and lupus.

Purpose of the Study:

  • To summarize the spectrum of cardiac involvement in various juvenile rheumatic diseases.
  • To highlight the diagnostic challenges and prognostic implications of cardiac manifestations in children.
  • To emphasize the importance of early detection and management of cardiovascular complications.

Main Methods:

  • Review of existing literature on cardiovascular manifestations in juvenile rheumatic diseases.
  • Analysis of clinical presentations, diagnostic findings, and outcomes.
  • Synthesis of key points regarding specific conditions like Kawasaki disease, lupus, JIA, and systemic sclerosis.

Main Results:

  • Pericarditis is the most common cardiac finding in systemic lupus erythematosus (SLE) and can lead to cardiac tamponade.
  • Conduction abnormalities are prevalent in juvenile mixed connective tissue disease and systemic sclerosis.
  • Pulmonary hypertension significantly contributes to mortality in juvenile systemic sclerosis, and cardiac involvement in juvenile systemic sclerosis is linked to poor outcomes.

Conclusions:

  • Cardiac involvement in juvenile rheumatic diseases requires vigilant monitoring due to potential for severe complications and long-term sequelae.
  • Early diagnosis and intervention, particularly in Kawasaki disease to prevent coronary artery aneurysms, are critical.
  • Childhood-onset rheumatic diseases can predispose individuals to diastolic dysfunction and premature atherosclerosis in adulthood.

Keywords:
Cardiac diseasesCardiovascular manifestationsJuvenilePaediatric rheumatologyPoor outcomeSevere organ manifestation

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