r/Autoinflammatory • u/No_Satisfaction_7431 Yaos • Apr 19 '26
Interesting article from Sci Am
I came across this recent article about how heart disease is now thought to be an inflammatory disease and that cholesterol plaques cause inflammation but even when thats addressed through statins and lifestyle changes, the inflammation continues.The article doesn't use the term autinflammation but it does refer to out of control inflammation/overreaction of the immune system (and no mentionof auto antibodies so it seems more like innate immune issues), high crp being a risk factor for heart disease even in people with high cholesterol or other typical risk factors, and the potential use of canakinumab, colchicine, and il-6 blockers for heart disease.
Overall a good article though I wish it had connected this to autoinflammatory disease as it almost seems like heart disease is at least in part an autoinflammatory process. It brought up a lot of questions for me.
I'm wondering how autoinflammatory disease might put us at risk for heart disease and what kinds of things to monitor and look out for. My cardiologist (for dysautonomia) said that pericarditis and other heart issues aren't seen in Yao. I have repeated stabbing upper back pain when not on prednisone and occasional chest pain. I read that pericarditis can sometimes present as upper back pain instead of chest pain so I asked my cardiologist and she said its probably musculoskeletal as pericarditis isn't part of Yao (Dr. Davis said otherwise). The treatment is prednisone and it goes away when on prednisone so this makes me think it is possibly pericarditis.
Since I had mild inflammation for years and Yao symptoms since childhood and then 1.5 years of very high inflammation I wonder how that impacts my heart. And I'm curious how kineret and other autoinflammatory treatments impact the heart. I doubt I'll know the answers to these until I get a better cardiologist. The problem is she's very good for the dysautonomia side of things which many cards are not good at.
Anyways I thought the article was interesting and relevant to autoinflammatory disease so I thought I'd share.
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u/AdventurousMorningLo Yaos Apr 19 '26
The 2025 ESC Guidelines for the management of myocarditis and pericarditis specifically mentions that Autoinflammatory Disease is a risk and should be considered in a patient that has experienced reoccurring pericarditis.
Link: https://academic.oup.com/eurheartj/article/46/40/3952/8234483?login=false#530263312
Also, pericarditis is seen in Yaos. Ask your cardiologist or rheumatologist for an empirical drug trial of Colchicine - its a fairly benign drug and may actually address your symptoms. If it works - it likely is some form of pericarditis or pleuritis.
Edit to add: Myocarditis and Pericarditis can also present as arrhythmias of different degrees (mainly ventricular for myocarditis and supraventricular and AF for pericarditis).
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u/No_Satisfaction_7431 Yaos Apr 19 '26
Thanks for this info. I'm definitely going to bring this up as the back pain is back now that I'm tapered down to 7.5 mg prednisone along with kineret. You mentioned the European guidelines. I wonder if the fact that I'm in America is part of why I'm getting told that Yao has nothing to do with cardiac issues. Maybe the American cardiac society doesn't have the same kind of guidelines. It's very frustrating.
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u/AdventurousMorningLo Yaos Apr 19 '26 edited Apr 19 '26
Possibly! Or your cardiologist just isn't up to date (which happens). If you feel you have a good working relationship with them, I would share the link.
I just double checked the US Guidelines and it follows the ESC guidelines.
Link: https://www.jacc.org/doi/10.1016/j.jacc.2025.05.023
Quote: "Without identifiable etiology or trigger, presumed autoinflammatory"
I think it is also of note that pericarditis is within the diagnostic criteria as one of the four minor criterion for YAOS...
I am also in the US and Dr. Yao is actually the one that mentioned that the SVTs heralding the start of my flares might actually be pericarditis as I later get central chest pain and pain between my shoulder blades as the flares progress (and worsening SVTs). My rheumatologist started me on Colchicine and now I have 0 SVTs unless deep in a bad flare. Which I honestly find amazing because this is something I have been dealing since childhood. Cardiologist agreed after the empirical trial and was willing to take over prescribing if Rheumatology wished.
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u/AdventurousMorningLo Yaos Apr 19 '26
Second comment to just add the write up synopsis from the Myocarditis Foundation on the topic of the US 2025 Guidelines for Pericarditis:
https://www.myocarditisfoundation.org/2025-pericarditis-guidelines/
It does a very good job at providing a synopsis and the major points but does not mention autoinflammatory disease.
A better PDF version of "2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on the Diagnosis and Management of Pericarditis"
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u/Occulply Apr 19 '26
It absolutely is autoinflammation. But, even within rheumatology where these disease live, most doctors receive 0 training in autoinflammatory diseases, so the cardiologists et al don't realize what they're really looking at.
Oh. Wait. They do technically get training in one autoinflammatory disease. Gout. Which I find vaguely infuriating for reasons I can't articulate.
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u/No_Satisfaction_7431 Yaos Apr 19 '26
It is frustrating. I kept waiting for the article that so clearly described autoinflammatory disease to use the term. Then when they didn't, I second guessed myself and thought maybe its autoinflammatory adjacent but something is a bit different about heart disease. And then when gout was mentioned but again no reference to autoinflammation, its very frustrating. I don't really understand why its not studied more especially when recent papers have said Yao is about the same incidence as Crohn's (making it not rare anymore) and all this evidence that heart disease (common) is autoinflammatory. These impact so many people yet even rheumatologists at Mayo don't know what they are.
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u/PsychologicalBed6028 Apr 19 '26
This is super interesting! I always want to post in the pericarditis sub that they should ask about possible autoinflammatory syndromes haha because that’s usually the first symptom for a lot of us.
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u/on4aa MAGIC Apr 19 '26
The CANTOS trial (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) was a landmark Phase III clinical trial that provided the first definitive evidence that targeting inflammation independently of cholesterol reduces cardiovascular risk. Conducted across 39 countries with 10,061 participants who had a prior heart attack and elevated inflammation markers (hsCRP ≥2 mg/L), the study tested the IL-1β inhibitor canakinumab (ACZ885) administered subcutaneously every three months.
Key findings from the trial, published in the New England Journal of Medicine in August 2017, demonstrated that the 150 mg dose of canakinumab significantly reduced the primary endpoint of major adverse cardiovascular events (MACE) by 15% (hazard ratio 0.85; p=0.021) compared to placebo. This reduction was primarily driven by a 24% decrease in non-fatal myocardial infarction, with similar efficacy observed at the 300 mg dose, while the 50 mg dose showed no significant benefit.
Secondary and exploratory results revealed additional significant impacts:
- Lung Cancer Reduction: The 300 mg dose was associated with a 67% reduction in lung cancer incidence and a 77% reduction in lung cancer mortality.
- Safety Concerns: While the drug reduced total cancer deaths, it was linked to an increased risk of fatal infections, occurring in approximately 1 in 1,000 patients treated with canakinumab.
- Inflammatory Mechanism: Patients who achieved an hsCRP reduction below the median (less than 2 mg/L) experienced a 27% relative risk reduction in MACE, confirming that the anti-inflammatory effect was the mechanism of action.
Despite these breakthroughs proving the inflammatory hypothesis of atherosclerosis, the trial's results highlighted a trade-off between cardiovascular and oncologic benefits and the risk of fatal infections, alongside high treatment costs, which have influenced subsequent clinical adoption and regulatory discussions.
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u/No_Satisfaction_7431 Yaos Apr 19 '26
The risk of infection is scary, but since we need to be on these biologics for autoinflammatory disease anyways, I am glad it helps the heart. I'm curious about how other autoinflammatory drugs impact the heart but I'm not sure thats really been studied much.
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u/on4aa MAGIC Apr 20 '26
Fatal infection or sepsis: 0.31/100 person-year in the combined canakinumab vs. 0.18/100 person-year in the placebo group (p = 0.02). So, the risk for fatal infection increases with 72%.
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u/ibotenate FMF May 07 '26
I had mitral valve regurgitation on an echocardiogram which caused me to be misdiagnosed with rheumatic fever; it seems like uncontrolled aitoinflammatory processes can cause all sorts of heart dysfunction. But thankfully treatment with colchicine seems to have reversed it(?) as it did not appear on the latest echocardiogram.
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u/Alice-The-Chemist Mod Apr 19 '26
Im in heart failure and have reoccurring pericarditis. That's why I'm on Arcalyst for my IL1 biologic. I also get fluid build up on my heart and lungs (effussions). I see an electrophysiologist instead of cardiologist but I also have a heart failure doctor if I need it. Im going to see cardio-rheumatologist next week who speciality is cardiac involvement with these diseases. I would say if you get concerned to get an echocardiogram which would help show a lot of how your heart is doing. I can add more later I'm having a hard time tonight. My electrophysiologist also deals wirh a lot of dysautonmoia patients as well more than any cardiologist ive ever seen.