MOFFITT AM REPORT PEARLS 10/10/16: Cardiac and Hematologic Effects of RA!

Hi Everyone! Thanks to Dave, Satvik, and Annie for presenting three interesting mini-cases this morning. Great pearls from all three, but to keep this succinct, we’ll focus on our first case, an elderly gentleman with rheumatoid arthritis who presented with pancytopenia and likely cardiac volume overload. We talked a bit about cardiac and hematologic effects of RA, related syndromes, and medications.

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Top pearls:

  • Felty syndrome = seropositive RA and neutropenia, usually with splenic enlargement
  • LGL syndrome = proliferation of large granular lymphocytes with risk of progression to LGL leukemia (1/3 of LGL leukemia patients have RA)

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For those who want more info:

 

Cardiac effects of rheumatoid arthritis:

  • Pericarditis and myocarditis are rare
  • Increased risk of CAD, MI, stroke, heart failure, atrial fibrillation, and sudden death

 

 

Hematologic effects of rheumatoid arthritis:

  • Mild normocytic anemia is common in patients with active disease
  • Felty syndrome = seropositive RA and neutropenia. May also have anemia, thrombocytopenia, and enlarged spleen (>90%).
  • LGL (large granular lymphocyte) proliferation, may progress to leukemia (1/3 of LGL leukemia patients have RA)
  • Increased risk of lymphoma in RA (both treated and untreated)

 

Methotrexate effects:

  • U.S. Boxed Warning for bone marrow suppression, GI toxicity, hepatotoxicity, opportunistic infections, pneumonitis, secondary malignancy, tumor lysis, and pregnancy
  • Thrombocytopenia is most common CBC abnormality in RA patients on MTX (3-10%)
  • Secondary malignancy (particularly lymphoma)

 

Etanercept effects:

  • U.S. Boxed Warning for infection, TB, and lymphoma as well as other malignancies
  • Heart failure is rare (<3%)
  • Pancytopenia and aplastic anemia are rare

 

Evernote: https://www.evernote.com/shard/s272/sh/5b915511-6694-4919-9a0a-bdc10154a469/b937e70963a68657e32272347d0e57b8

Have a great day everyone!

SamMy

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