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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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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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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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AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
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Several cytokine receptors have tightly bound Janus kinase or JAK proteins attached at their cytosolic tail. Small signaling molecules such as cytokines, growth hormones, or prolactins bind to the cytokine receptors and initiate their dimerization. The dimerization brings the cytosolic JAKs together that trans-phosphorylate and activates each other. The activated JAKs now phosphorylate cytosolic tails of the cytokine receptors, which serve as binding sites for adaptor proteins such as  SH2...
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Trends in Rheumatoid Arthritis Mortality in the United States, 1999-2020.

Aamir Shahzad1, Haji Bahar Ali2, Muhammad Bilal3

  • 1Department of Trauma and Orthopedic Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Greater Manchester OL6 9RW, United Kingdom.

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Rheumatoid arthritis (RA) mortality significantly decreased until 2019, but then sharply increased in 2020. Disparities in RA mortality persist among racial/ethnic groups and rural populations.

Keywords:
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Area of Science:

  • Rheumatology
  • Public Health
  • Epidemiology

Background:

  • Rheumatoid arthritis (RA) is a chronic inflammatory disease linked to systemic complications and increased mortality.
  • Advances in RA treatment were expected to reduce associated mortality rates.

Purpose of the Study:

  • To analyze national trends in rheumatoid arthritis (RA)-related mortality in the U.S. from 1999 to 2020.
  • To assess changes and disparities in RA mortality by sex, age, race/ethnicity, region, and urbanicity.

Main Methods:

  • Retrospective analysis of the WONDER multiple-cause-of-death database for RA as the underlying cause (ICD-10 codes M05.x, M06.x, M08.0).
  • Calculated age-adjusted mortality rates (AAMR) and used joinpoint regression to evaluate trends and annual percent change (APC).
  • Stratified analysis by demographic and geographic factors.

Main Results:

  • RA mortality declined by approximately -2% to -3% annually from 1999 to 2019, but rose sharply in 2020.
  • Significant disparities observed: higher mortality in females, persistent high rates in American Indians/Alaska Natives, and rural populations.
  • A 2020 mortality rebound was noted, particularly among Black and Hispanic populations, and in non-metropolitan areas.

Conclusions:

  • While RA mortality decreased overall until 2019, gains were unequally distributed, with persistent disparities.
  • The alarming rise in RA mortality in 2020 may be linked to the COVID-19 pandemic.
  • Addressing recent increases and persistent demographic gaps in RA outcomes requires ongoing research and targeted interventions.