Collateral cardiovascular damage in inflammatory joint diseases: Focus on cardiac dysfunction

This thesis aims to improve knowledge about the role of systemic inflammation in the development of cardiovascular disease and particularly cardiac dysfunction. Furthermore, to elucidate the added value of cardiac screening in this population. In Part I of this thesis including chapters 2-5, we focus on the role of inflammation in the development of CVD in IJD patients. Chapter 2 describes the prevalence, pathophysiology, and guidelines for CVD in IJD, i.e. RA and gout. In chapter 3 we reviewed the current literature on the effect of anti-inflammatory treatment, i.e. anti-TNF, on the cardiac function and the prevalence and incidence of CHF in RA. We performed echocardiography to assess the effect of anti-TNF on the cardiac function in RA patients with active disease in chapter 4. Part I finishes with chapter 5 describing a case report of a SLE patient with SLE induced heart failure with preserved ejection fraction (HFpEF) where the heart failure was treated with anti-inflammatory therapy. In part II, we focus on the role of systemic inflammation and cardiac diseases in AS patients. In this light, in chapter 6, we performed a large cross-sectional study in AS patients and osteoarthritis (OA) controls, the CARDAS study, to assess the prevalence of cardiac valve disease, conduction disturbances and cardiac dysfunction in AS. In our aim to identify a subgroup of AS patients at risk for aortic valve disease, in chapter 7, we performed a sub study of the CARDAS study to assess the association between HLAB27 genotype and aortic root dilatation and aortic valve regurgitation. Finally, part III reports on clinical trials focusing on relation between systemic inflammation and cardiovascular disease beyond the heart. In chapter 8, we conducted a cross-sectional controlled study in AS patients and healthy controls to assess the difference in retinal vasculature and to assess the value of retinal screening for cardiovascular disease. Furthermore, we assessed the effect of anti-inflammatory therapy on insulin resistance and body composition in RA patients in chapter 9.