O estudo tem por objetivo compreender o movimento entre sentir-se saudável e sentir-se doente nos diferentes modos de andar a vida de crianças e adolescentes com febre reumática e cardiopatia reumática. O recorte do objeto foi elaborado a partir das discussões sobre: a doença crônica e condição crônica, febre reumática e cardiopatia como doenças crônicas específicas e particularidades da condição crônica gerada pela febre reumática e pela cardiopatia reumática em crianças e adolescentes. O quadro teórico teve como base a discussão teórico-epistemológica do processo saúde-doença para a aproximação de uma outra discussão central, a fronteira entre o normal e o patológico. Os participantes foram crianças e adolescentes com febre reumática e cardiopatia reumática atendidos no Ambulatório de Cardiologia Pediátrica de um hospital universitário de Cuiabá- MT e suas mães. A coleta de dados ocorreu por meio da análise de documentos e da entrevista aberta que se efetivou no hospital, na residência e no local de trabalho. Os resultados e discussão deram origem a cinco temas: 1. Apresentação dos participantes: uma breve história, no qual se descreve como se conformou o curso da febre reumática e da cardiopatia reumática; 2. Contexto da assistência à criança e ao adolescente, no qual se evidenciou a produção de cuidados baseada no modelo clínico especializado e a fragmentação da assistência; 3. Noções sobre a febre reumática e a cardiopatia reumática segundo os participantes, no qual surge um saber fragmentado, com noções ora do modelo etiológico endógeno ora do modelo etiológico ontológico. 4. Repercussão da condição crônica gerada pela febre reumática e pela cardiopatia reumática na vida de crianças e adolescentes, no qual se discorre sobre a trajetória e as repercussões dessa condição crônica mostrando as dificuldades relacionadas aos sintomas, à hospitalização, à escola, às limitações, aos amigos, às brincadeiras, aos jogos e às particularidades da adolescência. 5. O movimento entre sentir-se saudável e sentir-se doente, no qual surgem situações que impõem normas de tratamento e evidencia que o modo de andar a vida dos participantes se baseia em diferentes normalidades, que influenciam, ou não, a adesão ao tratamento. A partir dessas situações surgem conflitos entre sentir-se saudável e ser classificado como doente. Nas considerações finais sugere-se a discussão junto aos profissionais de saúde e nas instituições formadoras sobre os princípios do SUS nos diferentes níveis da atenção à saúde, como forma de amenizar a fragmentação da assistência; a necessidade de trabalhar com o gerenciamento da condição crônica, sempre buscando conhecer as diferentes normalidades que fundamentam o modo de andar a vida de crianças e adolescente, considerando que as normas ditadas pelos profissionais de saúde não são as únicas que permeiam suas vidas e, por fim, a busca de estratégias para o fortalecimento de crianças, adolescentes em condição crônica e suas famílias, como maneira de ampliar a compreensão delas sobre a própria condição crônica para que as normas ditadas pelos profissionais de saúde sejam aceitas não por crença, mas por compreensão de que podem ampliar o leque de possibilidades de ser feliz. / This study aims at knowing the idea between feeling healthy and feeling ill in the different ways of children and teenager’s lives, with rheumatic fever and rheumatic heart disease. This study issue was made based on the discussions about: the chronic disease and the chronic condition, rheumatic fever and heart disease as chronic and specific diseases and particularities of the chronic condition generated by the rheumatic fever and by the rheumatic heart disease in the children and teenagers’ lives. The theoretical chart was based on a theoretical-epistemological discussion of the heath-disease process to get to another central discussion, the frontier between the normal and the pathological. The participants were children and teenagers who had rheumatic fever and rheumatic heart disease cared in the Policlinic of the Pediatric Cardiology of a university hospital in Cuiabá-MT and their mothers. The data were collected through the analysis of documents and open interviews which happened in the hospital, in the households and in their work. The results and discussion gave rise to five themes: 1. Presentation of the participants: a brief historical part in which it is described how the rheumatic fever and the rheumatic heart disease were confirmed in their lives; 2. The context of assistance to the children and the teenagers, in which the production of care based on the specialized clinical model and the fragmentation of the assistance was shown. 3. Notions about rheumatic fever and the rheumatic heart disease, in which a fragmented knowledge appears, sometimes with notions of the endogenous etiologic model and sometimes with notions of the ontological etiologic model. 4. Effects of the chronic condition brought by the rheumatic fever and by the rheumatic heart disease in the children and teenagers’ way of living, in which the trajectory and the effects of this chronic condition is discussed, showing the problems related to the symptoms, hospitalization, school classes, limitations, friends, children’s play, games and the particularities of the adolescence period. 5. The idea between feeling healthy and feeling ill, when there are situations that impose rules for treatment and highlights that the way the participants live, is based on a different kind of normality, which influence or not, the adhesionto the treatment. From these situations, other conflicts arise between feeling healthy and being classified as ill. In the final considerations, the discussion with the health professionals and in the institutions that teach about the principles of SUS in the different levels of the health care is suggested as a way of easing the assistance fragmentation; the need of working with the chronic condition, always trying to know the different kinds of normality which explain the children and teenagers’ way of living considering that the rules set up by the health professionals are not the only ones that permeate their lives and, finally, the search for strategies for the children and teenagers’ strengthening with a chronic condition and their families, as a way of widening their understanding about their chronic condition so that the rules established by the health professionals are accepted not by belief but by understanding that they can enlarge the possibilities of being happy.

Microorganismos da cavidade oral têm sido admitidos como causadores de doenças sistêmicas com reconhecido mecanismo de disseminação via corrente sangüínea. Diferentes fatores, incluindo a presença da doença periodontal, têm influência no risco de bacteremia oral, podendo ocasionar endocardite infecciosa por Streptococcus viridans. Sendo assim, a manutenção da saúde bucal adquire elevado grau de importância em gestantes portadoras de doença valvar reumática, em que o risco de endocardite infecciosa é eminente. A escassez científica fez deste tema o objetivo deste estudo: investigar a condição clínica periodontal de gestantes portadoras de cardiopatia valvar, identificando agentes periodontopatógenos nas amostras coletadas de saliva, sulco/bolsa periodontal, Para tanto, foram estudadas 52 gestantes cardiopatas (GC) e 70 gestantes não-cardiopatas (GNC). A condição periodontal foi avaliada empregando-se profundidade clínica de sondagem (PCS), nível clínico de inserção (NCI), linha esmalte cemento/margem gengival (LEC/MG), índice de sangramento (IS) e índice de placa bacteriana (IP). As seguintes médias foram obtidas para os parâmetros periodontais avaliados: PCS: 1.52 (GC) e 1.45 (GNC); NCI: 1.13 (GC) e 1.02 (GNC); LEC/MG: 0.41 (GC) e 0.40 (GNC); IS: 7.34 (GC) e 6.27 (GNC) e IP: 12.19 (GC) e 13.48 (GNC). Não houve diferença entre os grupos para o NCI (p= 0,612). A presença da Porphyromonas gingivalis na saliva foi maior (p= 0,007) no GNC, porém não houve diferença nas amostras de sulco/bolsa periodontal. / Microorganisms of the oral cavity are known to cause systemic diseases, spread through sanguine current. Different factors, including the presence of periodontal disease, influencing the risk of oral bacteremia could cause infectious endocarditis for Streptococcus viridans. Nevertheless, the maintenance of the oral health is extremely important in pregnant women with rheumatic valvar disease, in which the risk of infectious endocarditis is eminent. The aim of this study was to investigate the clinical periodontal condition of pregnant women with valvar disease and to identify the presence of Porphyromonas gingivalis in saliva and subgingival samples. For these purposes, we studied 52 pregnant with valvar disease (GC) and 70 healthy pregnant women (GNC). The following periodontal parameters were evaluated: probing depth (PCS), clinical attachment level (NCI), gingival margin location (LEC/MG), bleeding on probing (IS) and plaque index (IP). The following mean periodontal parameters were obtained: PCS: 1.52 (GC) e 1.45 (GNC); NCI: 1.13 (GC) e 1.02 (GNC); LEC/MG: 0.41 (GC) e 0.40 (GNC); IS: 7.34 (GC) e 6.27 (GNC) e IP: 12.19 (GC) e 13.48 (GNC). There was no statistical difference for NCI among the groups. There was no difference between periodontal clinical conditions in pregnant women with valvar disease and healthy pregnant women. The presence of the Porphyromonas gingivalis in saliva samples of healthy pregnant women is statistically higher than in pregnant woman with valvar disease; however, there was no difference in periodontal samples

A Febre Reumática, complicação tardia de uma infecção de orofaringe causada pelo Streptococcus pyogenes (estreptococo -hemolítico do grupo A de Lancefield), tem como conseqüência a Cardiopatia Reumática, explicada pelo mimetismo molecular entre proteínas cardíacas humanas e a associação de proteínas e carboidratos da membrana do S. pyogenes. A profilaxia secundária com a PGB 1.200.000 UI IM propõe-se a evitar novos surtos, sendo administrada em intervalos de vinte e um dias nos países com alto índice de estreptococcia. A lesão valvar predispõe à Endocardite Infecciosa, que resulta de bacteriemias causadas por focos infecciosos de origem bucal em cerca de 40% dos casos. Os Streptococcus Viridans constituem o grupo mais comumente encontrado nas Endocardites Infecciosas, em especial os Streptococcus sanguinis e Streptococcus oralis. O efeito do uso crônico da PGB não foi estudado com especificidade para essa microbiota. Assim, foi avaliada, qualitativa e quantitativamente, a microbiota bucal de 100 pacientes, aos 7 e 21 dias, após profilaxia secundária para a Febre Reumática com a PGB 1.200.000 UI IM e comparada com a de 100 pacientes portadores de doença arterial coronariana sem antecedentes de Febre Reumática. As espécies avaliadas foram divididas em S. sanguinis, S. oralis e outras espécies de Streptococcus Viridans Foram coletadas amostras de saliva pela mastigação de goma de parafina e transportadas em meio VMGA II S. As culturas foram semeadas em ágar Columbia CNA com 5% de sangue desfibrinado puro de carneiro com acréscimo de penicilina G. e incubadas a 35ºC em estufa de CO2 por 72 horas. As colônias sugestivas de Streptococcus foram submetidas a testes bioquímicos para confirmação de gênero e espécie. A concentração inibitória mínima foi determinada pelo método Etest e interpretada segundo os padrões do Clinical and Laboratory Standards Institute. Não houve diferença quanto à presença do S. sanguinis nos grupos estudados (P=0,40). O S. oralis prevaleceu aos 7 dias de PGB em relação ao grupo controle (P=0,01). Quanto à identificação de outras espécies, houve maior número de cepas nos pacientes do grupo controle quando comparados aos do grupo de estudo aos 7 e 21 dias de PGB (P<0,001). Os números de UFC/ml de S. sanguinis, S. oralis e de outras espécies foram comparados entre os grupos e não houve diferença entre eles (P=0,96; P=0,60 e P=0,77; respectivamente). Quanto às CIM do S. sanguinis e do S. oralis, não houve diferença entre os grupos (P=0,79 e P=0,13; respectivamente). Todos os testes estatísticos foram realizados em um nível de significância de 5%. Concluiu-se que o S. oralis prevaleceu aos 7 dias de PGB 1.200.000 UI IM; os Streptococcus Viridans de outras espécies prevaleceram no grupo controle; o número de UFC/mL de saliva não diferiu nos grupos estudados, a susceptibilidade dos S. sanguinis e S. oralis à penicilina G não foi alterada pela ação da PGB 1.200.000 UI IM a cada 21 dias e, por fim, a PGB não provocou reações de hipersensibilidade em nenhum paciente do estudo / Rheumatic fever is the result of a Streptococcus pyogenes (group A -hemolytic Streptococcus) infection of the upper respiratory tract. Rheumatic heart disease is a rheumatic fever consequence and is elucidated by the molecular mimicry between human cardiac proteins and group A streptococcal proteins and carbohydrates association. The secondary prophylaxis with 1,200,000 U BPG every three weeks is used for prevention of recurrent rheumatic fever in developing countries. Valvar defects are a risk for infective endocarditis which is resulted of bacteriemia caused for oral infectious focuses in 40% of cases. Viridans streptococci are the predominant group recovered in infective endocarditis, specially Streptococcus sanguinis and Streptococcus oralis. The effect of chronic BPG wasnt studied with specificity to these pathogens yet. Therefore, the oral microbiota was evaluated, qualitatively and quantitatively, at 7 and 21 days after secondary prophylaxis with BPG to rheumatic fever (study group), in a hundred patients and in comparison to another hundred patients with coronary heart disease who never acquired rheumatic fever (control group). The species evaluated were divided in S. sanguinis, S. oralis and another Streptococcus species. It was collected samples of chewing-stimulated saliva (1ml) and transported in VMGA II S medium. The samples were cultured in pure and with penicillin G 5% sheep blood Columbia ágar (CNA), incubated for 72 hours in an atmosphere containing 5% CO2 at 35ºC. The strains that were suggestive to Streptococcus were identified by biochemical tests to confirm bacteria species and genus. Minimal inhibitory concentration was determined by Etest method and interpreted in accordance to Clinical and Laboratory Standards Institute. The results showed that there was no difference in S. sanguinis presence in all groups (P=0.40). S. oralis prevailed in 7 days BPG group in comparison to control group (P=0.01). The control group showed the highest number of others species in comparison to 7 and 21 days BPG (P<0.001). CFU/ml numbers of S. sanguinis, S. oralis and other species strains were compared in 7 and 21 days BPG to control group and there was no difference among themselves (P=0.96, P=0.60 and P=0.77; respectively). There was no difference in S. sanguinis and S. oralis MICs among the study and control groups (P=0.79 and P=0.13). All statistic tests were done at 5% significance level. It was concluded that S. oralis prevailed in 7 days BPG group in comparison to control group; other species of Viridans streptococci prevailed in control group. The number of CFU/mL did not differ in both studied groups; the penicillin susceptibility of S. sanguinis and S. oralis did not change by BPG every three weeks and, by the end, it was not observed hypersensitivity reactions to penicillin in neither of the patients of this study

Human endogenous retroviruses are the remnants of ancient retroviral infections present within our genome. These molecular fossils show similarities with present day exogenous retroviruses but act as typical Mendelian elements that are passed vertically between generations. Despite being repeatedly linked to a number of autoimmune diseases and disorders, no conclusive proof has been identified. Rheumatoid arthritis (RA) is one such disease which has been associated with an increase in HERV expression, compared to controls. In order to elucidate a clear role for HERVs in RA pathogenesis, autoantigens implicated in disease pathogenesis were scanned for sequence homology to retroviral genes. Such epitopes would induce antibodies cross reactive with host proteins, resulting in disease. Short peptides mimicking these regions were synthesised and the prevalence of anti-HERV antibodies was determined in RA patients and disease controls. Additionally, a novel real-time Polymerase Chain Reaction (PCR) assay was developed to accurately quantify levels of HERV-K (HML-2) gag expression, relative to normalised levels of housekeeping gene expression. Both serological and molecular assays showed significant increases in HERV-K (HML-2) activity in RA patients compared to disease controls with CD4+ lymphocytes harbouring the highest activity. The real-time assay was also used to determine whether factors within the synovium could modulate HERVs, resulting in their upregulation. Exogenous viral protein expression and pro-inflammatory cytokines were shown to exert a significant modulatory effect over HERV-K (HML-2) transcription. From this data, it is clear that RA patients have increased levels of HERV-K (HML-2) gag activity compared to controls. Despite this it is likely that factors within the synovium such as exogenous viral expression and pro-inflammatory cytokines also influence HERV-K (HML-2) transcription possibly contributing to a role of bystander activation, i.e. being influenced by external factors, rather than actively contributing to disease processes. The exact role of HERVs in RA pathology remains elusive; however this research proposes several mechanisms by which HERV-K (HML-2) may contribute to disease.

No description available.

Varón de 15 años, con 2 meses de enfermedad caracterizada por sudoración profusa y dolor en miembros inferiores que le dificultaba caminar. El dolor aumento de intensidad asociándose después a taquipnea y disnea al caminar 50 m más náuseas y vómitos, disnea en reposo y edema de miembros inferiores. Ingreso por Emergencia al Hospital Nacional Dos de Mayo (HNDM) el 27/04/2016, presentando a su ingreso palpitaciones y disnea a pequeños esfuerzos. El Servicio de Cardiología del HNDM, diagnostico : Insuficiencia aórtica y mitral severa, insuficiencia tricúspidea leve e hipertensión pulmonar. Pulso arterial: 104 lat/min, FR: 32 resp/min, PA: 110/50 mm Hg, T°: 36,5°C, choque de la punta en 7mo espacio intercostal izquierdo, Soplo diastólico III/IV en foco aórtico, S sistólico III/IV en foco mitral, pulso radial en martillo de agua. Glucosa 74 mg/dl., creatinina 0.47 mg/dl, antiesptreptolisina (ASO) : 355 IU/ml, AAN: negativo, Hb : 11.6 g/dl, Proteínas Totales: 6.09gr/dl, albumina: 3.19gr/dl, globulina : 2.90gr/dl, Ecocardiograma: dilatación severa de aurícula y ventrículo izquierdo, hipertrofia de VI, dilatación de aurícula derecha, dilatación de arteria pulmonar y ramas. Insuficiencia severa aórtica y mitral, insuficiencia tricuspídea leve. Sometido a reemplazo valvular, hubo notable mejoria. / 15 years old, male, with 2 months clinical record characterized by profuse sweating and lower limbs pain that produced trouble on walking. Increased pain intensity was associated to tachypnea nausea,vomiting and dyspnea after walking 50 m.Beside it he had dyspnea at rest and lower limb edema. He entered to Dos de Mayo National Hospital (HNDM) on 04.27.2016, presenting palpitations and dyspnea at small efforts. HNDM, Department of Cardiology, diagnosed : severe mitral and aortic insufficiency, mild tricuspid regurgitation and pulmonary hypertension. Arterial pulse: 104 beats/min, FR: 32 breaths/min, PA: 110/50 mm Hg, T °: 36.5 ° C, tip heart beat at 7th left intercostal space, diastolic murmur III/IV at aortic focus, systolic murmur III/IV at mitral focus, water hammer radial pulse, glucose 74 mg/dl, creatinine 0.47 mg/dL, antiesptreptolisina (ASO) : 355 IU/ml, AAN: negative, Hb: 11.6 g / dl, total proteins: 6.09gr/dl, albumin: 3.19gr/dL globulin : 2.90gr/dl, Echocardiogram : severe dilated atrium and left ventricle hypertrophy, dilated right atrium, pulmonary artery and branches dilatation. Severe aortic and mitral insufficiency, mild tricuspid regurgitation. After valve replacement, the patient showed remarkable improvement.

Class of 2012 / Specific Aims: To evaluate the presence of statistical information from clinical studies in official product labeling specific for disease-modifying anti-rheumatic drugs (DMARDs) used in the treatment of rheumatoid arthritis. Methods: Data were abstracted from official product labeling DMARDs with FDA approval for treatment of rheumatoid arthritis. Each document was examined for the presence of statement regarding a priori type 1 error rate, p-values, and measures of variance. Medications were classified as either biologic or non-biologic. Main Results: A total of 14 DMARDs, 7 biologics (50%) and 7 non-biologics (50%), were found to be FDA approved for the treatment of rheumatoid arthritis. Primary outcomes consisted of American College of Rheumatology (ACR) response rates, radiographic changes, and health assessment questionnaire score (HAQ). Any measure of variance and the presence of a p-value were both found in six (43%) of the drug labels. Inclusion of p- values was found to be significantly greater in biologics compared to non-biologics for both ACR and radiographic results. Inclusion of variance was found to be significantly greater in biologics compared to non-biologics for radiographic changes only. No package inserts contained statements regarding the a priori type I error rate. Conclusions: Measures of variance are not frequently included in product labeling for either biologic or non-biologic DMARDs. However, inclusion of variance and p-values for ACR response rates and radiographic changes were more likely to be reported for biologics therapies as compared to non-biologics. A statement regarding Type 1 error rates were absent from labels regardless of outcome assessed.

Inflammatory arthropathies and systemic rheumatic diseases (IASRDs) commonly involve the cardiovascular system, and are associated with high morbidity and mortality. Mechanisms of cardiovascular involvement in these clinical entities are not fully understood. Cardiovascular magnetic resonance (CMR) is the single imaging modality capable of assessing non-invasively cardiac function, strain, ischaemia, altered vascular function, perfusion, oedema/inflammation and fibrosis. Furthermore, magnetic resonance spectroscopy (MRS) can give further insights into the status of myocardial energetics and lipidosis. The pathophysiological mechanisms and phenotype of cardiovascular disease (CVD) in IASRDs need further clarification. CMR is an ideal tool for the early identification and monitoring of cardiac manifestations in patients with IASRDs. Hence, the aims of this D.Phil project were to (i) utilise CMR and MRS to study disease mechanisms in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc), and (ii) to assess the role of anti-cytokine therapies in abrogation of cardiovascular complications and effects on cardiovascular function in patients with RA, ankylosing spondylitis (AS) and psoriatic arthritis (PsA). First, we used CMR to assess myocardial structure and function in RA, SLE and SSc patients with no known cardiovascular symptoms. Patients and controls were stratified by the presence of traditional cardiovascular risk factors (CVRFs). Our data demonstrated no differences in overall left ventricular (LV) systolic function, size and mass between patients and matched controls. There were, however, impairments in regional function and myocardial deformation, which is most severe in RA, SLE and SSc patients with CVRFs. We also found evidence of impaired vascular function in RA, SLE and SSc, using pulse wave velocity (PWV) and aortic distensibility, and again, showed that patients with CVRFs demonstrated the most severe aberrations, while patients without CVRFs and controls with CVRFs had an intermediate phenotype. Abnormalities in vascular and regional function were most severe in patients with SSc. Also, we showed that impaired vascular function correlated with abnormal systolic myocardial strain and diastolic strain rate in all groups of IASRDs studied. These data have implications for the clinical care of patients with RA, SLE and SSc and show that there is extensive cardiovascular involvement in asymptomatic patients. These results also suggest that early identification and stratification of CVD in IASRDs, with non-invasive techniques like CMR, may permit earlier intervention, thus potentially reducing the effect of CVD on morbidity and mortality in IASRDs. Lastly, these data highlight the importance of early detection and aggressive management of co-existent traditional CVRFs, as they confer incremental risk of CVD in patients with IASRDs. Second, we used CMR for comprehensive phenotyping of tissue characteristics in patients with RA, SLE and SSc. Our data confirmed that subclinical myocardial changes are common in patients with IASRDs (even with apparently normal hearts), which can be detected using multiparametric CMR. In addition to focal areas of fibrosis (detected by late gadolinium enhancement [LGE]), there were also areas of focal myocardial oedema or inflammation (detected by T2-weighted imaging). Further, using more sensitive techniques such as native T1 mapping and extracellular volume (ECV) quantification, we were able to demonstrate even more areas of myocardial involvement in IASRD patients than conventional CMR techniques can reveal, with patients showing significantly larger areas of T1 abnormality and expanded ECV, which likely represent a combination of low grade inflammation and diffuse myocardial fibrosis that are well-described disease processes in this cohort. We also found that T1 and ECV measures were associated with subtle myocardial systolic and diastolic dysfunction. The results of this study suggest that CMR, particularly T1 and ECV quantification, can be used for early detection of subclinical myocardial involvement in IASRD patients, potentially serving as an early screening tool before overt LV dysfunction or irreversible myocardial damage occurs. Third, we utilised CMR to study myocardial perfusion in patients with RA, SLE and SSc. We found that myocardial perfusion was impaired in asymptomatic IASRD with no overt heart disease. Non-segmental, subendocardial perfusion defects consistent with microvascular dysfunction were present in 47%, 31% and 41% of RA, SLE and SSc patients, respectively. Furthermore, there was a significant correlation between MPRI and systolic and diastolic regional function in all groups of patients. In RA and SSc, there was also a correlation between myocardial perfusion reserve index (MPRI) and disease activity. SSc patients had the greatest burden of ECV expansion, and in this group ECV also correlated with MPRI. These data led us to hypothesise that myocardial ischaemia likely leads to impaired myocardial relaxation and diffuse fibrosis, which predate overt dysfunction in contractility. Fourth, we investigated the effect of TNF-alpha inhibitors on myocardial and vascular function and structure in RA, AS and PsA patients. We confirmed that anti-TNF therapy was associated with improvements in serum inflammatory parameters like CRP and ESR, as well as with improved clinical measures of disease activity. Anti-TNF therapy, however, was not related to a change in left ventricular size, mass and global systolic function. We found that inhibition of TNF-alpha activity does result in better myocardial strain and strain rate, likely reflecting an improvement in myocardial inflammatory burden. Moreover, these findings were also supported by improvements in T2 weighted measures, native T1 values and ECV calculations. There was, however, no significant change in myocardial perfusion following anti-TNF therapy. These results support the hypothesis that during episodes of disease activity, myocardial oedema is present in patients with IASRDS and that by reducing the systemic inflammatory response, improvements in myocardial and vascular function can be achieved. Finally, we used CMR and MRS in asymptomatic RA and SLE patients (with normal hearts on echocardiography) to investigate cardiac metabolic status in this cohort. We found that myocardial energetics were impaired in patients, despite preserved overall ejection fraction. Interestingly, abnormal myocardial energetics were associated with presence of LGE, decreased myocardial perfusion, expanded ECV, volume fraction of T1 >990ms (which represents >2 standard deviations above the mean T1 value at 1.5T) and left atrial size. We did not find any difference in myocardial and hepatic lipid content between patients and controls. These data clearly demonstrate that abnormalities in cardiac energetics are present in IASRD patients even before the development of overt cardiac dysfunction, and may be driven by microvascular function and fibrosis.

No description available.

No description available.