Cardiac involvement in adult-onset Still's disease: Manifestations, treatments and outcomes in a retrospective study of 28 patients

• Published in: Journal of autoimmunity Vol. 116; p. 102541
• Main Authors: Bodard, Quentin, Langlois, Vincent, Guilpain, Philippe, Le Quellec, Alain, Vittecoq, Olivier, Noel, David, Eble, Vincent, Josse, Séverine, Schmidt, Jean, Aouba, Achille, Levesque, Hervé, Le Besnerais, Maelle, Benhamou, Ygal
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-01-2021; Elsevier
• Subjects: Adult-onset Still's disease; Biotherapy; Cardiac involvement; Life Sciences; Myocarditis; Pericarditis; Tamponade; CRP; TNFα; bDMARDs; MRI; PMNs; DMARDs; Tamponade; AOSD + C; MTX; sICAM-1; SF; TTU; NSAIDs; RHL; WBC; Pericarditis; AOSD; ECG; Myocarditis; Biotherapy; ANA; RF; PAH; Cardiac involvement; Adult-onset Still's disease
• ISSN: 0896-8411; 1095-9157
• DOI: 10.1016/j.jaut.2020.102541

Adult-onset Still's disease (AOSD) is a rare inflammatory disease that may be life-threatening if complicated by cardiac problems. We performed a retrospective multicenter study to describe the manifestations, treatments and outcomes of cardiac involvement in AOSD.
We reviewed the medical databases of eight centers. All AOSD patients identified as fulfilling Yamagushi's or Fautrel's criteria were included in the study. Cardiac involvement, clinical manifestations, laboratory features, the course of the disease and treatments were evaluated.
We included 96 AOSD patients in this study: 28 (29%) had documented cardiac involvement (AOSD + C group) and 68 (71%) had no cardiac involvement (control group). Cardiac complications were observed at diagnosis in 89% of cases. It were pericarditis (n = 17), tamponade (n = 5), myocarditis (n = 5) and non-infectious endocarditis (n = 1). Levels of leukocytes, neutrophils and C-reactive protein were significantly higher (p = 0.02, p = 0.02 and p = 0.002, respectively in the AOSD + C group than in the control group. Admission to intensive care, and the use of biotherapy were more frequent during follow-up in the AOSD + C group than the control group (p = 0.0001 and p = 0.03 respectively). Cardiac involvement was associated with refractory form in multivariate analyzed (p = 0.01). Corticosteroids were effective with or without methotrexate in 71% of patients but not in severe involvement as myocarditis or tamponade.
Cardiac complications are frequent, inaugural, can be life-threatening and predictive of a refractory course in patients with AOSD. Systematic cardiac screening should be proposed at diagnosis and biotherapy early use should be considered especially in myocarditis.
•About 30% of Adult onset Still's disease developed cardiac involvement.•AAdmission to intensive care and use of biotherapy were more frequent during follow-up in AOSD + C group than control group.•Cardiac involvement was associated with refractory form in multivariate analyzed.