Abstract
The paper describes the case of a patient affected by a combination of genetic and autoimmune diseases (multiple sclerosis, psoriatic arthritis, Leiden V mutation, and sicca syndrome) and hypertension. The psoriatic arthritis was treated with celecoxib and multiple sclerosis with fingolimod. The patient developed high fever and endocarditis, resulting in severe mitral regurgitation, atrial fibrillation, and congestive heart failure. Evidence is suggestive of adverse effects of potent immunosuppressive and anti-inflammatory therapies with biologic agents and the cardiovascular system. Fingolimod increases susceptibility to infections and induced endocarditis resulting in severe mitral regurgitation, atrial fibrillation, and congestive heart failure. Managed care systems limit the contact among basic care physicians and specialists. However, the process by which the optimal decision may be reached for a patient with a complex pathology is shared decision making, where the risk of severe complications and medical expenses may be reduced.
References
Gasparyan, A. Y., Stavropoulos-Kalinoglou, A., Mikhailidis, D. P., Toms, T. E., Douglas, K. M., & Kitas, G. D. (2010). The rationale for comparative studies of accelerated atherosclerosis in rheumatic diseases. Current Vascular Pharmacology, 8, 437–449.
Schneider, S., Schmitt, G., & Richter, W. (2006). Prevalence and correlates of inflammatory arthritis in Germany: Data from the First National Health Survey. Rheumatology International, 27, 29–38.
John, H., Kitas, G., Toms, T., & Goodson, N. (2009). Cardiovascular comorbidity in early rheumatoid arthritis. Best Practice & Research. Clinical Rheumatology, 23, 71–82.
John, H., Toms, T. E., & Kitas, G. D. (2011). Rheumatoid arthritis: Is it a coronary heart disease equivalent? Current Opinion in Cardiology, 26, 327–333.
Gasparyan, A. Y., Ayvazyan, L., Cocco, G., & Kitas, G. D. (2012). Adverse cardiovascular effects of antirheumatic drugs: Implications for clinical practice and research. Current Pharmaceutical Design, 18, 1543–1555.
Wolfe, F., & Michaud, K. (2004). Heart failure in rheumatoid arthritis: Rates, predictors, and the effect of anti-tumor necrosis factor therapy. American Journal of Medicine, 116, 305–311.
Sarzi-Puttini, P., Atzeni, F., Shoenfeld, Y., & Ferraccioli, G. (2005). TNF-alpha, rheumatoid arthritis, and heart failure: A rheumatological dilemma. Autoimmunity Reviews, 4, 153–161.
Ontaneda, D., & Cohen, J. A. (2011). Potential mechanisms of efficacy and adverse effects in the use of fingolimod (FTY720). Expert Review of Clinical Pharmacology, 4, 567–570.
Pelletier, D., & Hafler, D. A. (2012). Fingolimod for multiple sclerosis. The New England Journal of Medicine, 366, 339–347.
Marin-Garcia J, Goldenthal MJ, Moe (2007) Post-genomic cardiology. Elsevier Academic Press, NY, 228.
Gelfand, J. M., Neimann, A. L., Shin, D. B., Wang, X., Margolis, D. J., & Troxel, A. B. (2006). Risk of myocardial infarction in patients with psoriasis. Journal of American Medical Assosciation, 296(1735–174), 1. doi:10.1001/jama.296.14.1735.
Anema JM, Eijenbrok MW, Faes TJC, Heimans JJ, Lanting, Polman CH. Cardiovascular autonomic function in multiple sclerosis. Journal of Neurol Sciences 1991;104:129–134. doi.10.1016/0022-510x(9190301-M.
Flachenecker, P., Reiners, K., Krauser, M., Wolf, A., & Toyka, K. V. (2001). Autonomic dysfunction in multiple sclerosis is related to disease activity and progression of disability. Multiple Sclerosis, 7, 327–334. doi:10.1177/135245850100700509.
Lisi, S., Sisto, M., Lofrumento, D. D., & D’Amore, M. (2011). Sjögren’s syndrome autoantibodies provoke changes in gene expression profiles of inflammatory cytokines triggering a pathway involving TACE/NF-κB. Laboratory Investigation. doi:10.1038/labinvest.2011.190.
Baddour, L. M., Wilson, W. R., Bayer, A. S., Fowler, V. G., Bolger, A. F., Levison, M. E., et al. (2005). Infective endocarditis. Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: Endorsed by the Infectious Diseases Society of America. Circulation, 112, 2373. doi:10.1161/CIRCULATIONAHA.105.167942.
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The author is deeply indebted to G. Conti M.D. (Palm Springs, California) for the revision and useful medical comments.
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Cocco, G. A Patient with Leiden V Mutation, Multiple Sclerosis, Psoriasis, and Sicca Syndrome: Could Celecoxib and Fingolimod Adversely Affect the Heart?. Cardiovasc Toxicol 12, 266–272 (2012). https://doi.org/10.1007/s12012-012-9166-y
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DOI: https://doi.org/10.1007/s12012-012-9166-y