Mitral valve granulomatosis: A paradoxical reaction complicating etanercept treatment in rheumatoid arthritis. A case report

Ngoufack, Caroline; Semerano, Luca; Podglajen, Isabelle; Bruneval, Patrick; Meune, Christophe; Valeyre, Dominique; Dhôte, Robin; Boissier, Marie‐Christophe; Saidenberg-Kermanac’h, Nathalie

doi:10.1016/j.jbspin.2021.105183

Cited by 7 publications

(3 citation statements)

References 10 publications

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“…In addition, other clinical signs of toxicity, cutaneous, ocular and neuromyopathy are absent in her. Amyloid infiltration of conductive tissue has been reported by Thery et al [7,13]; This appears to be the only documented case of cardiac amyloidosis secondary to rheumatoid arthritis that resulted in atrioventricular block. This involvement is rare, no case out of the 62 Lebowitz patients [8] had a major conductive disorder despite the presence of 10 cases of cardiac amyloidosis [2].…”

Section: Discussionmentioning

confidence: 70%

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2024

IJCMCR

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Rheumatoid Arthritis (RA) is a chronic autoimmune joint disease characterized by persistent systemic inflammation.In rheumatoid arthritis, cardiac involvement is not uncommon and may involve all three tunics of the heart. We report an exceptional case of RA associated with complete Atrioventricular Block (AVB) and intracardiac mobile mass. This is a patient with RA initially put on chloroquine, complicated by a complete BAV implanted with a double chamber pace, then put on corticosteroid therapy and methotrexate for four years. Faced with the worsening of his osteoporosis and the probable increase in the threshold of pacemaker stimulation, it was decided to replace methotrexate with leflunomide. As part of the patient's cardiac evaluation, an ETT was performed, inadvertently objectifying a mass in the right atrium attached to the atrial tube and the tricuspid valve without obstruction.Full BAV is very rare. It can be seen especially in old polyarthritis. Several mechanisms can explain this, including rheumatoid nodules; Chloroquine poisoning; amyloid infiltration and rheumatoid vasculitis.The association of RA and intracardiac mass is rare. By analyzing the few cases described in the literature, five main causes are summarized: rheumatoid nodules, cancers, granulomatosis of valves, intracavitary thrombus and infective endocarditis.We discuss through our case, the epidemiological and etiological particularity of the association of RA with a major conductive disorder, as well as the difficulty of the etiological diagnosis of an intracardiac mass in the context of RA.

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Section: Discussionmentioning

confidence: 70%

“…A clinical case was reported in 2021 by Ngoufack et al [13] describing granulomatous cardiac valve localization complicating treatment with etanercept, in the form of a mobile mass on the mitral valve, in a 26-year-old patient with rheumatoid arthritis.…”

Section: Discussionmentioning

confidence: 99%

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2024

IJCMCR

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“…A biological TNF antagonist inhibiting the interaction of TNF-α and lymphotoxin (TNF-β) with cell-surface receptors, whereby TNF-mediated cellular responses and the activity of other pro-inflammatory cytokines are modulated. [181][182][183][184]…”

Section: Etanercept)mentioning

confidence: 99%

Recent Advances in Understanding the Pathogenesis of Rheumatoid Arthritis: New Treatment Strategies

Mueller

Payandeh

Mohammadkhani

et al. 2021

Cells

104

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Rheumatoid arthritis (RA) is considered a chronic systemic, multi-factorial, inflammatory, and progressive autoimmune disease affecting many people worldwide. While patients show very individual courses of disease, with RA focusing on the musculoskeletal system, joints are often severely affected, leading to local inflammation, cartilage destruction, and bone erosion. To prevent joint damage and physical disability as one of many symptoms of RA, early diagnosis is critical. Auto-antibodies play a pivotal clinical role in patients with systemic RA. As biomarkers, they could help to make a more efficient diagnosis, prognosis, and treatment decision. Besides auto-antibodies, several other factors are involved in the progression of RA, such as epigenetic alterations, post-translational modifications, glycosylation, autophagy, and T-cells. Understanding the interplay between these factors would contribute to a deeper insight into the causes, mechanisms, progression, and treatment of the disease. In this review, the latest RA research findings are discussed to better understand the pathogenesis, and finally, treatment strategies for RA therapy are presented, including both conventional approaches and new methods that have been developed in recent years or are currently under investigation.

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