Rheumatoid Arthritis - Inflammation Can Affect You Internally

Rheumatoid arthritis can inflame blood vessels (vasculitis) and membrane around the lungs (pleurisy), the sac around the heart (pericarditis), or inflammation and scarring of the lungs themselves that may lead to chest pain, difficulty breathing, abnormal heart function and swollen lymph nodes.

In the article, "Rheumatoid Arthritis - Not Just A Disease Of The Joints" (Issue 125 of Arthritis Today) it states: "Rheumatoid arthritis is a complicated condition; affecting internal organs such as the heart and lungs as well as the joints."

Myocarditis

The myocardium is the muscular wall of the heart, or the heart muscle. It contracts to pump blood out of the heart and then relaxes as the heart refills with returning blood.
Myocarditis is an inflammation of the myocardium. When the heart becomes inflamed, it cannot pump as well because of damage to its cells and swelling (edema). The heart muscle may be damaged even more if your body's immune system sends antibodies to try to fight whatever started the inflammation.

What causes myocarditis?

Myocarditis is a rare condition. The inflammation of the heart muscle may be caused by a viral, bacterial, or fungal infection.
Rheumatic fever, which can occur if the antibodies that your body sends to fight a strep infection attack the tissues of your joints or heart instead.
Drug or chemical poisoning.
Connective tissue diseases, such as lupus or rheumatoid arthritis.

With a mild case of myocarditis, you may not feel any symptoms at all. You may have a fever, an achy feeling in your chest, and severe fatigue, as if you have a bad cold or flu. Some people have an irregular heartbeat (arrhythmia) or trouble breathing.

Myocarditis is hard to diagnose because it can resemble many other diseases. Your doctor may suspect that you have myocarditis if your symptoms have appeared within 6months of having an infection.

Electrocardiography (an ECG or EKG) can help doctors learn more about your heart rhythm and the size and function of the chambers of your heart.

Echocardiography can be used to see heart wall motion and overall heart size.

How is myocarditis treated?

Myocarditis is treated with pain relievers and anti-inflammatory medicines. If myocarditis is part of another illness (such as rheumatoid arthritis), treating that illness will treat the heart as well. If myocarditis is caused by a bacterial infection, antibiotic medicines will be prescribed.

MedlinePlus
www.nlm.nih.gov/medlineplus/
Medical Encyclopedia > Mg-Mz > Myocarditis

Updated July 2007

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The treatments of RA might increase the risk of heart disease. Non-steroidal anti-inflammatory drugs, such as Ibuprofen, may lead to a rise in blood pressure. Steroids may accelerate the development of arterial thickening and narrowing.
Methotrexate may increase the blood levels of homocysteine, which in turn could promote the development of heart disease.
Folic acid helps to reverse this effect of methotrexate, which is one reason why most rheumatologists prescribe folic acid with methotrexate.
On the other hand, methotrexate and steroids reduce the amount of inflammation in RA and so the benefits of these drugs with regard to heart disease probably far outweigh the risks.
It is important to try and reduce RA disease activity, be aware of the risk of heart disease report and investigate symptoms which suggest early cardiovascular disease – such as angina, calf pain when exercising and mini strokes.

Rheumatoid arthritis can affect any part of the body. We tend to think of it as a disease of the joints, however, its been known for a long time that the heart and lungs can also be affected in a significant way.
Sometimes medications used to treat rheumatoid arthritis may result in lung disease.
It's important to consult your doctor promptly if you have rheumatoid arthritis and experience any unexplained breathing problems.
Men, although less likely to develop RA overall are more likely to be affected by heart or lung problems. Those who smoke or who have bad joint disease are at greater risk.
Some patients may develop an inflammation of the lining of the heart or lungs causing a sharp pain on breathing in. This is often called pleurisy (lungs) or pericarditis (heart).
It may occur early in RA and often needs anti-inflammatory drugs and occasionally steroids to improve.
An X ray of the lungs, or Echo (ultrasound) of the heart can confirm the diagnosis of fluid around these organs and this may complicate the inflammation and might need to be removed with a syringe and needle under local anaesthetic.

Inflammatory Pancreatic Disease

Until 1995, when autoimmune pancreatitis was first described, pancreatitis was considered a disease induced exclusively by alcoholism.
The pancreas is an endocrine gland situated in the abdominal cavity that helps regulate blood glucose levels and assists with the digestion of fatty lipids. Inflammation of the pancreas, which is known as pancreatitis, has traditionally been associated with alcohol abuse.
However, in 1995 researchers first described a form of chronic pancreatitis associated with autoimmune manifestations.
Today it's known that about 5-6 percent of all cases of chronic pancreatitis are autoimmune in nature. And according to recent reports, the incidence of autoimmune pancreatitis appears to be rising, particularly in Japan, Europe, the United States, and Korea.
Autoimmune pancreatitis is considered a benign disorder because patients typically respond favorably to treatment with corticosteroids.
Autoimmune pancreatitis is also known by other names including lymphoplasmacytic sclerosing pancreatitis with cholangitis, idiopathic duct destructive pancreatitis, primary inflammatory pancreatitis, non-alcoholic duct destructive chronic pancreatitis, pseudotumorous pancreatitis, tumefactive pancreatitis, and destructive pancreatitis depending on the specific tissue changes found on biopsy or the predominant and accompanying symptoms.

Who Is Affected?

Autoimmune pancreatitis occurs in twice as many men as women. The initial presentation usually occurs between ages 50-60, but patients can also develop autoimmune pancreatitis as early as age 30 as well as late in life.
Autoimmune pancreatitis can occur as alone or in association with other autoimmune disorders including sclerosing cholangitis, primary biliary cirrhosis, inflammatory bowel disease, rheumatoid arthritis, hypothyroidism, sarcoidosis, and Sjogren's syndrome.
In addition, autoimmune pancreatitis has been seen in association with retroperitneal fibrosis and lung nodules.
Because certain markers of autoimmune pancreatitis, such as IgG4 positive plasma cells can be detected in other tissues besides the pancreas in affected patients, some researchers believe that autoimmune pancreatitis may be a systemic autoimmune disease affecting multiple organs besides the pancreas, including the gallbladder, bile ducts, salivary glands, lungs, biliary tree, and the kidney's renal tubules.
Signs and Symptoms:
Signs of autoimmune pancreatitis include elevated levels of gamma globulins and marked elevations of alkaline phosphatase with only slight elevations of transaminase enzymes, elevated serum IgG4 levels, and autoantibodies directed against carbonic anhydrase and lactoferrin. The blood sugar may also be elevated and the stools may have increased fat content.
The pancreas is often enlarged and is surrounded by a halo of lymphocytes and plasma cells. Granulomas may also be present around the ducts of the pancreas, and a mass may obstruct the ducts.
Autoimmune pancreatitis can cause a wide variety of symptoms that tend to occur as a relapsing-remitting type of disease, with periods of symptoms alternating with periods of remission. Common symptoms include jaundice, weight loss, and mild abdominal pain. Severe abdominal pain or other symptoms of acute pancreatitis are unusual.
Diagnosis
Blood tests for carbonic anhydrase and lactoferrin antibodies are positive in autoimmune pancreatitis. Imaging tests show an enlarged pancreas with white blood cell infiltration and fibrosis. Cross-sectional imaging shows diffuse gland enlargement and a long attenuated segment of the pancreatic duct. A favorable response to corticosteroids also differentiates autoimmune pancreatitis from alcohol-induced pancreatitis. Because a mass obstructing the biliary ducts is often seen in autoimmune pancreatitis, autoimmune pancreatitis must be differentiated from pancreatic cancer with fine needle aspiration biopsy and tissue studies of the pancreas.

Resources:
Dmitry Finkelberg, Dushyant Sahani, Vikram Deshpande, and William Brugge, Autoimmune Pancreatitis, The New England Journal of Medicine, vol 355:2670-2676, Dec 21, 2006.