EN PL
SHORT COMMUNICATION
Pulmonary arterial hypertension in rheumatological practice: insidious beginning – severe consequences. The importance of early detection
 
More details
Hide details
 
Online publication date: 2010-11-16
 
 
Reumatologia 2010;48(5):293-300
 
KEYWORDS
ABSTRACT
Pulmonary arterial hypertension (PAH) is a chronic, progressive disease leading to death. It is important in rheumatological practice as a leading cause of mortality in systemic sclerosis. PAH can be a complication of other connective tissue diseases. During the last decade there has been substantial progress in understanding of PAH pathogenesis, leading to the introduction of new therapies. However, the response to modern therapies in scleroderma-related PAH seems to be less promising compared to other forms of PAH. One of the reasons may be diagnosis delay. In this context introduction of effective screening procedures seems to be crucial. Nowadays, yearly echocardiography is recommended in all patients with systemic sclerosis and symptomatic patients with other connective tissue diseases (CTD). Investigations to optimize the screening algorithm with new echocardiographic techniques and use of biomarkers (NT-proBNP) are under way. The suspicion of PAH has to be confirmed by right heart catheterization. The review discusses current strategy to diagnose and assess CTD-related PAH in everyday practice.
REFERENCES (43)
1.
Humbert M, Segal ES, Kiely DG, et al. Results of European postmarketing surveillance of bosentan in pulmonary hypertension. Eur Respiratory J 2007; 30: 338-344.   .
 
2.
Badesch DB, Champion HC, Sanchez MAG, et al. Diagnosis and assessment of pulmonary arterial hypertension. JACY 2009; 54: S55-S66.   .
 
3.
McGoon MD, Kane GC. Pulmonary hypertension: diagnosis and management. Mayo Clin Proc 2009; 84: 191-207.   .
 
4.
D’Alonzo GE, Baryt RJ, Ayres SM, et al. Survival in patients with primary pulmonary hypertension: results from a national prospective registry. Ann Intern Med 1991; 115: 343-349.   .
 
5.
Kuhn KP, Byrne DW, Arbogast PG, et al. Outcome in 91 ­consecutive patients with pulmonary arterial hypertension receiving epoprostenol. Am J Respir Crit Care Med 2003; 167: 580-586.   .
 
6.
Kawut SM, Taichman DB, Archer-Chicko CL, et al. Hemodynamics and survival in patients with pulmonary arterial hypertension related to systemic sclerosis. Chest 2003; 123: 344-350.   .
 
7.
Stupi AM, Steen VD, Owens GR, et al. Pulmonary hypertension in the CREST syndrome variant of systemic sclerosis. Arthritis Rheum 1986; 29: 515-524.   .
 
8.
Avouac J, Wipff J, Kahan A, et al. Effects of oral treatments on exercise capacity in systemic sclerosis related pulmonary arterial hypertension: a meta-analysis of randomized controlled trials. Ann Rhem Dis 2008; 67: 808-814.   .
 
9.
Hachulla E, Carpentier P, Gressin V, et al. Risk factors for death and the 3-year survival of patients with systemic sclerosis: the French IntinérAIR-Sclérodermie study. Rheumatology 2009; 48: 304-308. .
 
10.
Hachulla E, Launay D, Yaici A, et al. for French PAH-SSc network. Pulmonary arterial hypertension associated with systemic sclerosis in patients with functional class II dyspnoea: mild symptoms but severe outcome. Rheumatology 2010; 49: 940-944. .
 
11.
Kowal-Bielecka O, Landewé R, Avouac J, et al. EULAR recommendations for the treatment of systemic sclerosis. A report from the EULAR Scleroderma Trials and Research Group (EUSTAR). Ann Rheum Dis 2009; 68: 620-628. .
 
12.
Galie N, Manes A, Negro L, et al. A meta-analysis of randomised controlled trials in pulmonary arterial hypertension. Eur Heart J 2009; 30: 394-403. .
 
13.
Rich S. Primary pulmonary hypertension: executive summary. World Health Organization, Evian 1998. .
 
14.
Condliffe R, Kiely DG, Peacock AJ, et al. Connective tissue disease-associated pulmonary arterial hypertension in modern treatment era. Am J Respir Crit Care Med 2009; 179: 151-157. .
 
15.
Galie N, Rubin LJ, Hoeper M, et al. Treatment of patients with mildly symptomatic pulmonary arterial hypertension with bosentan (EARLY study): a double blind, randomized controlled trial. Lancet 2008; 371: 2093-2100. .
 
16.
Hubert M, Stibon O, Chaouat A, et al. Pulmonary arterial hypertension in France: results from a national registry. Am J Respir Crit Care Med 2006; 173: 1023-1030. .
 
17.
Hassoun PM. Therapies for scleroderma related pulmonary arterial hypertension. Expert Rev Respir Med 2009; 3: 187-196. .
 
18.
Sanchez-Roman, Opitz CF, Kowal-Bielecka O, et al. for the EPOSS-OMERACT Group. Screening for PAH in patients with systemic sclerosis: focus on Doppler echocardiography. Rheumatology 2008; 47: v33-v35. .
 
19.
McGoon M, Gutterman D, Steen V, et al. Screening, early detection and diagnosis of pulmonary arterial hypertension. ACCP evidence-based clinical practice guidelines. Chest 2004; 126: 14S-24S. .
 
20.
Bossone E, Paciocco G, Iarussi D, et al. The prognostic role of the ECG in primary pulmonary hypertension. Chest 2002; 121: 513-518. .
 
21.
British Cardiac Society Guidelines and Medical Practice Committee, and approved by the British Thoracic Society and British Society of Rheumatology. Recommendations on the management of pulmonary hypertension in clinical practice. Heart 2001; 86 (Suppl. 1): I1-I13. .
 
22.
Galie N, Torbicki A, Barst R, et al. Guidelines on diagnosis and treatment of pulmonary arterial hypertension. The task force on diagnosis and treatment of pulmonary arterial hypertension of the European Society of Cardiology. Eur Heart J 2004; 25: 2243-2248. .
 
23.
Barst RJ, McGoon M, Torbicki A, et al. Diagnosis and differential assessment of pulmonary arterial hypertension. J Am Coll Cardiol 2004; 43, 40S-47S. .
 
24.
Badesch DB, Abman SH, Simonneau G, et al. Medical therapy for pulmonary arterial hypertension: updated ACCP evidence-based clinical practice guidelines. Chest 2007; 131: 1917-1928. .
 
25.
National Pulmonary Hypertension Centers of the UK. Consensus statement on the management of pulmonary arterial hypertension in clinical practice in the UK and Ireland. Heart 2008; 94: i1-i41. .
 
26.
Galie N, Hoeper MM, Hubert M, et al. Guidelines on the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2009; 30: 2493-537. .
 
27.
Vachiery JL, Coghlan G. Screening for pulmonary arterial hypertension in systemic sclerosis. Eur Respir Rev 2009; 18: 162-169. .
 
28.
Milan A, Magnino C, Veglio F. Echocardiographic indexes for the non-invasive evaluation of pulmonary hemodynamics. J Am Soc Echocardiogr 2010; 23: 225-239. .
 
29.
Kowal-Bielecka O, Avouac J, Pittrow D, et al., for the EPOSS Group. Echocardiography as an outcome measure in scleroderma-related pulmonary arterial hypertension: a systematic literature analysis by the EPOSS Group. J Rheumatol 2010; 37: 105-115. .
 
30.
Sudoh T, Kangawa K, Minamino N, et al. A new natriuretic peptide in porcine brain. Nature 1988; 332: 78-81. .
 
31.
Dimitroulas T, Giannakoulas G, Karvounis H, et al. Natriuretic peptides in systemic sclerosis-related pulmonary arterial hypertension. Semin Arthritis Rheum 2010; 39: 278-284. .
 
32.
Fijałkowska A, Kurzyna M, Torbicki A, et al. Serum N-terminal brain natriuretic peptide as a prognostic parameter in patients with pulmonary hypertension. Chest 2006; 129: 1313-1321. .
 
33.
Allanore Y, Meune C. N-terminal pro brain natriuretic peptide: the new cornerstone of cardiovascular assessment in systemic sclerosis. Clin Exp Rheumatol 2009: 27: 59S-63S. .
 
34.
Dimitroulas T, Giannakoulas G, Karvounis H, et al. Neurohormonal activation in patients with systemic sclerosis-related pulmonary arterial hypertension. Int J Cardiol 2007; 121: 135-137. .
 
35.
Ciurzyński M, Bienias P, Lichodziejewska B, et al. Non-invasive diagnostic and functional evaluation of cardiac involvement in patients with systemic sclerosis. Clin Rheumatol 2008; 27: 991-997. .
 
36.
Allanore Y, Broderie D, Meune C, et al. N-terminal pro-brain natriuretic peptide as diagnostic marker of early pulmonary artery hypertension in patients with systemic sclerosis and effects of calcium-channel blockers. Arthritis Rheum 2003; 48: 3503-3508. .
 
37.
Williams MH, Handler CE, Akram R, et al. Role of N-terminal brain natriuretic peptide (NT-proBNP) in scleroderma associated pulmonary arterial hypertension. Eur Heart J 2006; 27: 1485-1494. .
 
38.
Allanore Y, Borderie B, Avouac J, et al. High N-terminal pro-brain natriuretic peptide levels and low diffusing capacity for carbone monoxide as independent predictors of the occurrence of precapillary pulmonary arterial hypertension in patients with systemic sclerosis. Arthritis Rheum 2008; 58: 284-291. .
 
39.
Owens GR, Fino GJ, Herbert DL, et al. Pulmonary function in progressive systemic sclerosis: comparison of CREST syndrome variant with diffuse scleroderma. Chest 1983; 84: 546-550. .
 
40.
Steen VD, Graham G, Conte C, et al. Isolated diffusing capacity reduction in systemic sclerosis. Arthritis Rheum 1992; 35: 765-770. .
 
41.
Miyamoto S, Nagaya N, Satoh T, et al. Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary arterial hypertension: comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med 2000; 161: 487-492. .
 
42.
Avouac J, Kowal-Bielecka O, Pittrow D, et al. Validation of the 6 min walk test according to the OMERACT filter: a systematic literature review by the EPOSS OMERACT group. Ann Rheum Dis 2010; 69: 1360-1363. .
 
43.
Więsik-Szewczyk E, Olesińska M. Postępowanie z chorymi na twardzinę układową. Pol Merkur Lek 2010; 28: 421-423.
 
Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
eISSN:2084-9834
ISSN:0034-6233
Journals System - logo
Scroll to top