Top

Current Rheumatology Reports

Published in:

01-12-2017 | Rheumatoid Arthritis (L Moreland, Section Editor)

Rheumatoid Arthritis-Associated Interstitial Lung Disease: Current Concepts

Authors: Yoel Brito, Marilyn K. Glassberg, Dana P. Ascherman

Published in: Current Rheumatology Reports | Issue 12/2017

Abstract

Purpose of Review

Among the many extra-articular complications of rheumatoid arthritis (RA), interstitial lung disease (ILD) contributes significantly to morbidity and mortality. Prevalence estimates for RA-ILD vary widely depending on the specific clinical, radiographic, and functional criteria used to establish the diagnosis. A key unresolved issue is whether early, subclinical forms of RA-ILD represent a precursor to end stage, fibrotic lung disease. Based on uncertainties surrounding the natural history of RA-ILD, incomplete understanding of underlying disease pathogenesis, and lack of controlled clinical trials, evidence-based therapeutic strategies remain largely undefined.

Recent Findings

Correlative clinico-epidemiological studies have identified key risk factors for disease progression. Complementing these findings, the identification of specific molecular and serological markers of RA-ILD has improved our understanding of disease pathogenesis and established the foundation for predictive biomarker profiling. Experience from case series and cohort studies suggests that newer biological agents such as rituximab may be viable treatment options.

Summary

RA-ILD continues to have a major impact on “disease intrinsic” morbidity and mortality. Increased understanding of disease pathogenesis and the natural history of subclinical RA-ILD will promote the development of more refined therapeutic strategies.

Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010;376(9746):1094–108. https://doi.org/10.1016/S0140-6736(10)60826-4.CrossRefPubMed

Shaw M, Collins BF, Ho LA, Raghu G. Rheumatoid arthritis-associated lung disease. Eur Respir Rev. 2015;24(135):1–16. https://doi.org/10.1183/09059180.00008014.CrossRefPubMed

Turesson C, O'Fallon WM, Crowson CS, Gabriel SE, Matteson EL. Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis. 2003;62(8):722–7.CrossRefPubMedPubMedCentral

Suda T. Up-to-date information on rheumatoid arthritis-associated interstitial lung disease. Clin Med Insights Circ Respir Pulm Med. 2015;9(Suppl 1):155–62. https://doi.org/10.4137/CCRPM.S23289.PubMed

Brown KK. Rheumatoid lung disease. Proc Am Thorac Soc. 2007;4(5):443–8. https://doi.org/10.1513/pats.200703-045MS.CrossRefPubMedPubMedCentral

• Gochuico BR, Avila NA, Chow CK, Novero LJ, Wu HP, Ren P, et al. Progressive preclinical interstitial lung disease in rheumatoid arthritis. Arch Intern Med. 2008;168(2):159–66. https://doi.org/10.1001/archinternmed.2007.59. Through the use of multiplex ELISA-based technology, this study examined the relationship between levels of various cytokines/chemokines in bronchoalveolar lavage fluid and subtype of RA-ILD, demonstrating that specific cytokine profiles predict radiographic progression in “subclinical” RA-ILD.CrossRefPubMed

Metafratzi ZM, Georgiadis AN, Ioannidou CV, Alamanos Y, Vassiliou MP, Zikou AK, et al. Pulmonary involvement in patients with early rheumatoid arthritis. Scand J Rheumatol. 2007;36(5):338–44. https://doi.org/10.1080/03009740701393957.CrossRefPubMed

Young A, Koduri G, Batley M, Kulinskaya E, Gough A, Norton S, et al. Mortality in rheumatoid arthritis. Increased in the early course of disease, in ischaemic heart disease and in pulmonary fibrosis. Rheumatology (Oxford). 2007;46(2):350–7. https://doi.org/10.1093/rheumatology/kel253.CrossRef

Ayhan-Ardic FF, Oken O, Yorgancioglu ZR, Ustun N, Gokharman FD. Pulmonary involvement in lifelong non-smoking patients with rheumatoid arthritis and ankylosing spondylitis without respiratory symptoms. Clin Rheumatol. 2006;25(2):213–8. https://doi.org/10.1007/s10067-005-1158-x.CrossRefPubMed

10.

Cortet B, Flipo RM, Remy-Jardin M, Coquerelle P, Duquesnoy B, Remy J, et al. Use of high resolution computed tomography of the lungs in patients with rheumatoid arthritis. Ann Rheum Dis. 1995;54(10):815–9.CrossRefPubMedPubMedCentral

11.

Demir R, Bodur H, Tokoglu F, Olcay I, Ucan H, Borman P. High resolution computed tomography of the lungs in patients with rheumatoid arthritis. Rheumatol Int. 1999;19(1–2):19–22.CrossRefPubMed

12.

Gabbay E, Tarala R, Will R, Carroll G, Adler B, Cameron D, et al. Interstitial lung disease in recent onset rheumatoid arthritis. Am J Respir Crit Care Med. 1997;156(2 Pt 1):528–35. https://doi.org/10.1164/ajrccm.156.2.9609016.CrossRefPubMed

13.

Georgiadis AN, Metafratzi ZM, Drosos AA. Pulmonary abnormalities in patients with early and longstanding rheumatoid arthritis. J Rheumatol. 2009;36(2):444–445; author reply 5-6. https://doi.org/10.3899/jrheum.080882.CrossRefPubMed

14.

Kelly C, Saravanan V. Treatment strategies for a rheumatoid arthritis patient with interstitial lung disease. Expert Opin Pharmacother. 2008;9(18):3221–30. https://doi.org/10.1517/14656560802591430.CrossRefPubMed

15.

•• Kim EJ, Elicker BM, Maldonado F, Webb WR, Ryu JH, Van Uden JH, et al. Usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease. Eur Respir J. 2010;35(6):1322–8. https://doi.org/10.1183/09031936.00092309. This study suggests that RA-UIP (as assessed by HRCT) carries an extremely poor prognosis paralleling that of IPF.CrossRefPubMed

16.

Mori S, Cho I, Koga Y, Sugimoto M. Comparison of pulmonary abnormalities on high-resolution computed tomography in patients with early versus longstanding rheumatoid arthritis. J Rheumatol. 2008;35(8):1513–21.PubMed

17.

Tanaka N, Kim JS, Newell JD, Brown KK, Cool CD, Meehan R, et al. Rheumatoid arthritis-related lung diseases: CT findings. Radiology. 2004;232(1):81–91. https://doi.org/10.1148/radiol.23210301742321030174.CrossRefPubMed

18.

Olson AL, Swigris JJ, Sprunger DB, Fischer A, Fernandez-Perez ER, Solomon J, et al. Rheumatoid arthritis-interstitial lung disease-associated mortality. Am J Respir Crit Care Med. 2011;183(3):372–8. https://doi.org/10.1164/rccm.201004-0622OC.CrossRefPubMedPubMedCentral

19.

Koduri G, Norton S, Young A, Cox N, Davies P, Devlin J, et al. Interstitial lung disease has a poor prognosis in rheumatoid arthritis: results from an inception cohort. Rheumatology (Oxford). https://doi.org/10.1093/rheumatology/keq035.

20.

Bongartz T, Nannini C, Medina-Velasquez YF, Achenbach SJ, Crowson CS, Ryu JH, et al. Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study. Arthritis Rheum. 2010;62(6):1583–91. https://doi.org/10.1002/art.27405.CrossRefPubMedPubMedCentral

21.

Hyldgaard C, Hilberg O, Pedersen AB, Ulrichsen SP, Lokke A, Bendstrup E, et al. A population-based cohort study of rheumatoid arthritis-associated interstitial lung disease: comorbidity and mortality. Ann Rheum Dis. 2017;76(10):1700–6. https://doi.org/10.1136/annrheumdis-2017-211138.CrossRefPubMed

22.

Antoniou KM, Margaritopoulos G, Economidou F, Siafakas NM. Pivotal clinical dilemmas in collagen vascular diseases associated with interstitial lung involvement. Eur Respir J. 2009;33(4):882–96. https://doi.org/10.1183/09031936.00152607.CrossRefPubMed

23.

Dawson JK, Fewins HE, Desmond J, Lynch MP, Graham DR. Predictors of progression of HRCT diagnosed fibrosing alveolitis in patients with rheumatoid arthritis. Ann Rheum Dis. 2002;61(6):517–21.CrossRefPubMedPubMedCentral

24.

Naz SM, Symmons DP. Mortality in established rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2007;21(5):871–83. https://doi.org/10.1016/j.berh.2007.05.003.CrossRefPubMed

25.

Flaherty KR, Mumford JA, Murray S, Kazerooni EA, Gross BH, Colby TV, et al. Prognostic implications of physiologic and radiographic changes in idiopathic interstitial pneumonia. Am J Respir Crit Care Med. 2003;168(5):543–8. https://doi.org/10.1164/rccm.200209-1112OC200209-1112OC.CrossRefPubMed

26.

Hunninghake GW, Zimmerman MB, Schwartz DA, King TE Jr, Lynch J, Hegele R, et al. Utility of a lung biopsy for the diagnosis of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2001;164(2):193–6. https://doi.org/10.1164/ajrccm.164.2.2101090.CrossRefPubMed

27.

• Kim EJ, Collard HR, King TE Jr. Rheumatoid arthritis-associated interstitial lung disease: the relevance of histopathologic and radiographic pattern. Chest. 2009;136(5):1397–405. https://doi.org/10.1378/chest.09-0444. This commentary summarizes other studies showing a close correlation between HRCT pattern and UIP histopathology as well as reduced survival in RA-UIP.CrossRefPubMedPubMedCentral

28.

O'Dwyer DN, Armstrong ME, Cooke G, Dodd JD, Veale DJ, Donnelly SC. Rheumatoid arthritis (RA) associated interstitial lung disease (ILD). Eur J Intern Med. 2013;24(7):597–603. https://doi.org/10.1016/j.ejim.2013.07.004.CrossRefPubMed

29.

Leslie KO, Trahan S, Gruden J. Pulmonary pathology of the rheumatic diseases. Semin Respir Crit Care Med. 2007;28(4):369–78. https://doi.org/10.1055/s-2007-985609.CrossRefPubMed

30.

Paulin F, Doyle TJ, Fletcher EA, Ascherman DP, Rosas IO. Rheumatoid arthritis-associated interstitial lung disease and idiopathic pulmonary fibrosis: shared mechanistic and phenotypic traits suggest overlapping disease mechanisms. Rev Investig Clin. 2015;67(5):280–6.

31.

Rajasekaran A, Shovlin D, Saravanan V, Lord P, Kelly C. Interstitial lung disease in patients with rheumatoid arthritis: comparison with cryptogenic fibrosing alveolitis over 5 years. J Rheumatol. 2006;33(7):1250–3.PubMed

32.

Park JH, Kim DS, Park IN, Jang SJ, Kitaichi M, Nicholson AG, et al. Prognosis of fibrotic interstitial pneumonia: idiopathic versus collagen vascular disease-related subtypes. Am J Respir Crit Care Med. 2007;175(7):705–11. https://doi.org/10.1164/rccm.200607-912OC.CrossRefPubMed

33.

Nurmi HM, Purokivi MK, Karkkainen MS, Kettunen HP, Selander TA, Kaarteenaho RL. Variable course of disease of rheumatoid arthritis-associated usual interstitial pneumonia compared to other subtypes. BMC Pulm Med. 2016;16(1):107. https://doi.org/10.1186/s12890-016-0269-2.CrossRefPubMedPubMedCentral

34.

• Yunt ZX, Chung JH, Hobbs S, Fernandez-Perez ER, Olson AL, Huie TJ, et al. High resolution computed tomography pattern of usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease: Relationship to survival. Respir Med. 2017;126:100–4. https://doi.org/10.1016/j.rmed.2017.03.027. This study of 158 RA-ILD patients demonstrates that individuals with HRCT patterns of definite/probable UIP have significantly reduced survival compared to patients with non-UIP radiographic abnormalities.CrossRefPubMed

35.

Solomon JJ, Chung JH, Cosgrove GP, Demoruelle MK, Fernandez-Perez ER, Fischer A, et al. Predictors of mortality in rheumatoid arthritis-associated interstitial lung disease. Eur Respir J. 2016;47(2):588–96. https://doi.org/10.1183/13993003.00357-2015.CrossRefPubMed

36.

Zamora-Legoff JA, Krause ML, Crowson CS, Ryu JH, Matteson EL. Patterns of interstitial lung disease and mortality in rheumatoid arthritis. Rheumatology (Oxford). 2017;56(3):344–50. https://doi.org/10.1093/rheumatology/kew391.

37.

• Morisset J, Vittinghoff E, Lee BY, Tonelli R, Hu X, Elicker BM, et al. The performance of the GAP model in patients with rheumatoid arthritis associated interstitial lung disease. Respir Med. 2017;127:51–6. https://doi.org/10.1016/j.rmed.2017.04.012. In this study, the authors demonstrate that the GAP (Gender, Age, Physiology) model (previously validated in IPF) performs extremely well as a predictor of survival in RA-ILD—suggesting that physiology/functional parameters may be more important than underlying histopathology in determining clinical outcome.CrossRefPubMed

38.

Agostini C, Gurrieri C. Chemokine/cytokine cocktail in idiopathic pulmonary fibrosis. Proc Am Thorac Soc. 2006;3(4):357–63. https://doi.org/10.1513/pats.200601-010TK.CrossRefPubMed

39.

Pardo A, Gibson K, Cisneros J, Richards TJ, Yang Y, Becerril C, et al. Up-regulation and profibrotic role of osteopontin in human idiopathic pulmonary fibrosis. PLoS Med. 2005;2(9):e251. https://doi.org/10.1371/journal.pmed.0020251.CrossRefPubMedPubMedCentral

40.

Rao RN, Goodman LR, Tomashefski JF Jr. Smoking-related interstitial lung disease. Ann Diagn Pathol. 2008;12(6):445–57. https://doi.org/10.1016/j.anndiagpath.2008.10.001.CrossRefPubMed

41.

Saag KG, Kolluri S, Koehnke RK, Georgou TA, Rachow JW, Hunninghake GW, et al. Rheumatoid arthritis lung disease. Determinants of radiographic and physiologic abnormalities. Arthritis Rheum. 1996;39(10):1711–9.CrossRefPubMed

42.

Thorley AJ, Tetley TD. Pulmonary epithelium, cigarette smoke, and chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2007;2(4):409–28.PubMedPubMedCentral

43.

Wilson MS, Wynn TA. Pulmonary fibrosis: pathogenesis, etiology and regulation. Mucosal Immunol. 2009;2(2):103–21. https://doi.org/10.1038/mi.2008.85.CrossRefPubMedPubMedCentral

44.

Yang Q, Underwood MJ, Hsin MK, Liu XC, He GW. Dysfunction of pulmonary vascular endothelium in chronic obstructive pulmonary disease: basic considerations for future drug development. Curr Drug Metab. 2008;9(7):661–7.CrossRefPubMed

45.

Shimizu S, Yoshinouchi T, Niimi T, Ohtsuki Y, Fujita J, Maeda H, et al. Differing distributions of CXCR3- and CCR4-positive cells among types of interstitial pneumonia associated with collagen vascular diseases. Virchows Arch. 2007;450(1):51–8. https://doi.org/10.1007/s00428-006-0330-2.CrossRefPubMed

46.

• Willis VC, Demoruelle MK, Derber LA, Chartier-Logan CJ, Parish MC, Pedraza IF, et al. Sputum autoantibodies in patients with established rheumatoid arthritis and subjects at risk of future clinically apparent disease. Arthritis Rheum. 2013;65(10):2545–54. https://doi.org/10.1002/art.38066. By showing that sputum autoantibodies (RF, CCP) often predate the development of serum autoantibodies in preclinical RA, this analysis provides evidence that the lung (rather than the joints) may represent the site in which immune tolerance toward relevant RA autoantigens is breached.PubMedPubMedCentral

47.

Reynisdottir G, Karimi R, Joshua V, Olsen H, Hensvold AH, Harju A, et al. Structural changes and antibody enrichment in the lungs are early features of anti-citrullinated protein antibody-positive rheumatoid arthritis. Arthritis Rheum. 2014;66(1):31–9. https://doi.org/10.1002/art.38201.CrossRef

48.

• Harlow L, Gochuico BR, Rosas IO, Doyle TJ, Osorio JC, Travers TS, et al. Anti-citrullinated heat shock protein 90 antibodies identified in bronchoalveolar lavage fluid are a marker of lung-specific immune responses. Clin Immunol. 2014;155(1):60–70. https://doi.org/10.1016/j.clim.2014.08.004. Through comparative epitope profiling of anti-citrullinated HSP90 protein/peptide autoantibodies in bronchoalveolar lavage fluid and serum, this study demonstrates both qualitative and quantitative differences in epitope recognition between these tissue compartments—providing direct evidence that the lung plays an important role in initiating and/or shaping the repertoire of antigen-specific B cell responses in RA.CrossRefPubMedPubMedCentral

49.

Giles JT, Darrah E, Danoff S, Johnson C, Andrade F, Rosen A, et al. Association of cross-reactive antibodies targeting peptidyl-arginine deiminase 3 and 4 with rheumatoid arthritis-associated interstitial lung disease. PLoS One. 2014;9(6):e98794. https://doi.org/10.1371/journal.pone.0098794.CrossRefPubMedPubMedCentral

50.

England BR, Thiele GM, Duryee MJ, et al. Associations of serum anti-malondialdehyde-acetaldehyde (MAA) antibodies with cardiovascular and respiratory mortality in men with rheumatoid arthritis. Arthritis Rheum. 2015;67(S10) http://acrabstract.org/abstract/associations-of-serum-anti-malondialdehyde-acetaldehyde-maa-anibodies-with-cardiovascular-and-respiratory-mortality-in-men-with-rheumatoid-arthritis/

51.

Smadja DM, Nunes H, Juvin K, Bertil S, Valeyre D, Gaussem P, et al. Increase in both angiogenic and angiostatic mediators in patients with idiopathic pulmonary fibrosis. Pathol Biol (Paris). 2014;62(6):391–4. https://doi.org/10.1016/j.patbio.2014.07.006.CrossRef

52.

Rosenbloom J, Mendoza FA, Jimenez SA. Strategies for anti-fibrotic therapies. Biochim Biophys Acta. 2013;1832(7):1088–103. https://doi.org/10.1016/j.bbadis.2012.12.007.CrossRefPubMed

53.

•• Chen J, Doyle TJ, Liu Y, Aggarwal R, Wang X, Shi Y, et al. Biomarkers of rheumatoid arthritis-associated interstitial lung disease. Arthritis Rheum. 2015;67(1):28–38. https://doi.org/10.1002/art.38904. This study demonstrated an association between RA-ILD and elevated serum levels of MMP-7 as well as IP10 in two independent cohorts of RA patients with varying stages of ILD.CrossRef

54.

• Doyle TJ, Patel AS, Hatabu H, Nishino M, Wu G, Osorio JC, et al. Detection of rheumatoid arthritis-interstitial lung disease is enhanced by serum biomarkers. Am J Respir Crit Care Med. 2015;191(12):1403–12. https://doi.org/10.1164/rccm.201411-1950OC. In this study, the authors demonstrate that combining specified clinical/serological parameters with levels of designated serum biomarkers (MMP-7, PARC, SP-D) yields a powerful tool for identification of both subclinical and clinically evident RA-ILD.CrossRefPubMedPubMedCentral

55.

Wang T, Zheng XJ, Ji YL, Liang ZA, Liang BM. Tumour markers in rheumatoid arthritis-associated interstitial lung disease. Clin Exp Rheumatol. 2016;34(4):587–91.PubMed

56.

Giles JT, Danoff SK, Sokolove J, Wagner CA, Winchester R, Pappas DA, et al. Association of fine specificity and repertoire expansion of anticitrullinated peptide antibodies with rheumatoid arthritis associated interstitial lung disease. Ann Rheum Dis. 2014;73(8):1487–94. https://doi.org/10.1136/annrheumdis-2012-203160.CrossRefPubMed

57.

•• Harlow L, Rosas IO, Gochuico BR, Mikuls TR, Dellaripa PF, Oddis CV, et al. Identification of citrullinated hsp90 isoforms as novel autoantigens in rheumatoid arthritis-associated interstitial lung disease. Arthritis Rheum. 2013;65(4):869–79. https://doi.org/10.1002/art.37881. Using a novel reverse immunophenotyping method, the authors identify antibodies targeting citrullinated isoforms of HSP90 as moderately sensitive, but highly specific, markers of RA-ILD.CrossRefPubMed

58.

Song ST, Kim SS, Kim JY, Lee SY, Kim K, Kwon IS, et al. Association of single nucleotide polymorphisms of PADI4 and HLA-DRB1 alleles with susceptibility to rheumatoid arthritis-related lung diseases. Lung. 2016;194(5):745–53. https://doi.org/10.1007/s00408-016-9916-x.CrossRefPubMed

59.

Oka S, Furukawa H, Shimada K, Hashimoto A, Komiya A, Fukui N, et al. Plasma miRNA expression profiles in rheumatoid arthritis associated interstitial lung disease. BMC Musculoskelet Disord. 2017;18(1):21. https://doi.org/10.1186/s12891-017-1389-4.CrossRefPubMedPubMedCentral

60.

Vij R, Strek ME. Diagnosis and treatment of connective tissue disease-associated interstitial lung disease. Chest. 2013;143(3):814–24. https://doi.org/10.1378/chest.12-0741.CrossRefPubMedPubMedCentral

61.

• Md Yusof MY, Kabia A, Darby M, Lettieri G, Beirne P, Vital EM, et al. Effect of rituximab on the progression of rheumatoid arthritis-related interstitial lung disease: 10 years’ experience at a single centre. Rheumatology (Oxford). 2017;56(8):1348–57. https://doi.org/10.1093/rheumatology/kex072. This retrospective analysis of 700 RA patients (56 with known RA-ILD) treated with rituximab suggests that this biologic agent may be effective in stabilizing and/or improving co-existing ILD.CrossRef

62.

Roubille C, Haraoui B. Interstitial lung diseases induced or exacerbated by DMARDS and biologic agents in rheumatoid arthritis: a systematic literature review. Semin Arthritis Rheum. 2014;43(5):613–26. https://doi.org/10.1016/j.semarthrit.2013.09.005.CrossRefPubMed

63.

Perez-Alvarez R, Perez-de-Lis M, Diaz-Lagares C, Pego-Reigosa JM, Retamozo S, Bove A, et al. Interstitial lung disease induced or exacerbated by TNF-targeted therapies: analysis of 122 cases. Semin Arthritis Rheum. 2011;41(2):256–64. https://doi.org/10.1016/j.semarthrit.2010.11.002.CrossRefPubMed

Title: Rheumatoid Arthritis-Associated Interstitial Lung Disease: Current Concepts
Authors: Yoel Brito
Marilyn K. Glassberg
Dana P. Ascherman
Publication date: 01-12-2017
Publisher: Springer US
Published in: Current Rheumatology Reports / Issue 12/2017
Print ISSN: 1523-3774
Electronic ISSN: 1534-6307
DOI: https://doi.org/10.1007/s11926-017-0701-5

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 12/2017

Clinical Outcome and Long-term Remission in JIA

Tendon Pathology in Hypercholesterolemia and Familial Hypercholesterolemia

Eosinophilic Fasciitis: an Updated Review on Diagnosis and Treatment

Can positive affect attenuate (persistent) pain? State of the art and clinical implications

B Cell-Based Treatments in SLE: Past Experience and Current Directions

The Microbiome and Bone and Joint Disease

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage