Cardiovascular involvement in rheumatic diseases is a topic of intense research and interest. Many forms of cardiac involvement have been described in inflammatory myopathies. At ACR 2016, Poster #2327 aimed to look at this issue further. A group from Spain analyzed a multicentre, retrospective cohort of patients from their study registry who were diagnosed with inflammatory myopathy (IM) according to the Bohan and Peter Criteria for myopathies. Patients were classified into 7 different clinical groups: dermatomyositis (DM), polymyositis (PM), juvenile DM, cancer-associated myositis (CAM), overlap myositis (OM), inclusion body myositis (IBM) and necrotizing myositis (NM).
The analysis comprised 478 patients, among whom 28% had PM, 22% DM, 20% OM, 19% juvenile DM, 8% CAM, 1.3% IBM, and 1.3% NM. Of these patients, 21% presented with cardiac involvement. This included 53 cases of arrhythmia, 25 cases of myocarditis and 30 cases of pericarditis. Certain factors were more commonly seen in patients with cardiac involvement, and these included older age at diagnosis (i.e. 55 years of age vs 40), and commonly DM patients. In addition, there was an association between cardiac involvement and pulmonary hypertension, dysphagia, calcinosis, and higher ESR, perhaps indicating more severe disease. Arrhythmia in particular was associated with older age and less calcinosis. Myocarditis was associated with dysphagia. Pericarditis was associated with Raynaud's and cancer. Fifty two percent of patients died, with 32% of these cases due to a cardiovascular event.
Overall, this study suggests that cardiac involvement may occur in 20% of cases of inflammatory myopathies. This risk confers an elevated mortality. More severe disease manifestations may confer increased cardiac risk (e.g. myocarditis and dysphagia).
Will these results change your practice? How often do you screen your myositis patients for cardiac issues, or address their cardiac risk factors?