Uyiekpen Ima-Edomwonyi: Why Autoimmune Inflammation Demands Early Vigilance?
Uyiekpen Ima-Edomwonyi, Consultant Rheumatologist at M.P. Shah Hospital, shared a post on LinkedIn:
“The Hidden Threat of Autoimmune Inflammation
It was a seemingly innocuous but persistent complaint that brought him to M.P. Shah Hospital.
Two years earlier Musa (fictitious name) had sustained a small injury on his leg – one that had refused to go.
He was not diabetic and did not have an infected bone.
He now had some leg swelling with it – what seemed to push him to the casualty.
He was duly admitted in a search for the likely suspects.
A leg clot (i.e deep vein thrombosis, aka DVT) was cleared by a Doppler ultrasound scan.
Kidneys were fine, so too the liver. Surprisingly, his heart was found to be pumping less than normal, but not the cause of his leg swelling which picked on only one leg. Technical name – Heart failure with reduced ejection fraction (aka HFrEf).
Then other facts came to light as the clinical interrogation of his health continued.
His tests confirmed it and further history affirmed it – he had rheumatoid arthritis, diagnosed a year earlier.
His small joints (knuckles on his hands and wrists) were painful, swollen and stiff intermittently over the last 3 years.
Closer inspection revealed his hand joints had started deforming, but had opted to discontinue treatment at some point.
Was his rheumatoid arthritis an innocent bystander or were all these findings connected?
Research has shown that there is a 1.5–2 times higher chance of Cardiovascular Disease risk and having a Major Adverse Cardiovascular Events (MACE) in autoimmune conditions like rheumatoid arthritis.
Silent vascular injury from the long-standing inflammation, can precede overt events. Cardiovascular events can be silent as chronic inflammation hums on in the body – not just in the joints.
This was the topic of my presentation and discussion with colleagues at the Nigerian Society of Rheumatology Conference this year as we looked at ‘The Hidden Threat in Chronic Inflammatory Arthropathies’.
The message was clear: early diagnosis, assessment and appropriate treatment of inflammatory conditions prevents cardiovascular risk.
There was also the message that Cardiovascular Disease assessment needs to be done with more vigilance in those with autoimmune inflammation.
Musa would have benefited from this information and avoided the vascular inflammation, his unhealing wound and his heart failure by controlling his inflammation – information that probably was not discussed and adequately explained to Musa well enough.”
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