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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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Rheumatic Heart Disease I: Introduction01:23

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Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
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Restrictive cardiomyopathy (RCM) is a rare heart muscle disease characterized by impaired ventricular filling due to stiffened ventricular walls, leading to significant diastolic dysfunction.EtiologyRestrictive cardiomyopathy can arise from both inherited and acquired diseases, many of which are systemic. It is categorized into four main types: infiltrative, storage, non-infiltrative, and endomyocardial diseases.Infiltrative diseases, such as amyloidosis, lead to RCM by depositing amyloid...
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Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
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Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
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Polymyalgia rheumatica.

Georgina Espígol-Frigolé1, Christian Dejaco2, Sarah L Mackie3

  • 1Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.

Lancet (London, England)
|October 13, 2023
PubMed
Summary
This summary is machine-generated.

Polymyalgia rheumatica causes pain and stiffness in older adults. While glucocorticoids help, new therapies like tocilizumab offer improved treatment options for this inflammatory condition.

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Area of Science:

  • Rheumatology
  • Immunology
  • Internal Medicine

Background:

  • Polymyalgia rheumatica (PMR) is an inflammatory condition affecting individuals over 50, causing shoulder and pelvic girdle pain and stiffness.
  • Diagnosis relies on excluding other conditions due to a lack of specific tests, with imaging aiding in pathological identification and detecting coexistent giant cell arteritis.
  • PMR significantly impacts quality of life, though it doesn't typically affect survival or organ function.

Purpose of the Study:

  • To review the current understanding of polymyalgia rheumatica, including diagnosis, management, and emerging therapies.
  • To highlight the challenges in assessing disease activity and managing relapses and side-effects associated with glucocorticoid treatment.
  • To discuss the potential of newer targeted therapies in improving patient outcomes.

Main Methods:

  • Review of existing literature on polymyalgia rheumatica, focusing on diagnostic criteria, treatment outcomes, and novel therapeutic agents.
  • Analysis of the role of imaging in diagnosis and disease activity assessment.
  • Evaluation of the efficacy and safety of current and emerging treatments, including glucocorticoids and biologics.

Main Results:

  • Glucocorticoids are effective for remission but associated with high relapse rates (40-60%) and common side-effects upon tapering.
  • Assessing disease activity is challenging due to comorbidities and altered inflammatory marker responses during treatment.
  • Tocilizumab and sarilumab have demonstrated efficacy in clinical trials, indicating promise for targeted therapies.

Conclusions:

  • Polymyalgia rheumatica requires careful management due to treatment challenges and quality of life impacts.
  • Emerging targeted therapies, such as IL-6 inhibitors, show promise for more effective and potentially safer treatment strategies.
  • A careful risk-benefit assessment is crucial when implementing new therapeutic innovations for polymyalgia rheumatica patients.