From the Guidelines
The treatment for psoriatic myocarditis should prioritize a combination of immunosuppressive therapy and cardiac supportive care to minimize morbidity, mortality, and improve quality of life. The most recent and highest quality study available is from 1, which highlights the association between psoriasis and increased risk of myocardial infarction, suggesting that the treatment approach should focus on addressing the underlying inflammatory pathways.
Key Considerations
- Initial management may include high-dose corticosteroids such as prednisone 0.5-1 mg/kg/day, which is gradually tapered over several months based on clinical response.
- For severe or refractory cases, additional immunosuppressants like methotrexate, cyclosporine, or mycophenolate mofetil may be added.
- TNF inhibitors such as infliximab or adalimumab are often effective since they target the underlying inflammatory pathways in both psoriasis and myocarditis.
- Cardiac supportive measures include ACE inhibitors, beta-blockers, and diuretics as needed for heart failure symptoms.
- Regular cardiac monitoring with echocardiography and possibly cardiac MRI is essential to track treatment response, as suggested by the understanding of psoriasis comorbidities from 1.
Treatment Approach
The treatment approach must be individualized and coordinated between rheumatologists and cardiologists, as psoriatic myocarditis represents an inflammatory cardiac complication of systemic psoriatic disease that requires addressing both the cardiac manifestation and the underlying autoimmune process. Given the chronic inflammatory nature of psoriasis and its potential to lead to adverse health outcomes including coronary artery disease and myocardial infarction, as noted in 1 and 1, a comprehensive treatment plan is crucial.
Coordination of Care
Coordination between specialists is key to managing psoriatic myocarditis effectively, ensuring that both the dermatological and cardiac aspects of the disease are adequately addressed. This approach is supported by the understanding that patients with psoriasis, especially those with severe presentations, have an increased frequency of comorbidities including cardiovascular disease, as discussed in 1.
From the Research
Psoriatic Myocarditis Treatment
There is limited information available on the treatment of psoriatic myocarditis. However, the following points can be considered:
- Psoriatic myocarditis is a rare condition, and there is no specific treatment available for it.
- Treatment of psoriatic arthritis and psoriasis with TNF-alpha inhibitors such as etanercept has been shown to be effective in reducing inflammation and improving symptoms 2, 3.
- Etanercept has been found to be safe and well-tolerated in patients with psoriasis and psoriatic arthritis, but caution should be exercised in patients with chronic heart failure, autoimmune disease, and previous malignancies 4.
- The use of etanercept in patients with psoriatic myocarditis may be considered, but more research is needed to determine its efficacy and safety in this specific condition.
TNF-Alpha Inhibitors
TNF-alpha inhibitors such as etanercept have been shown to be effective in reducing inflammation and improving symptoms in patients with psoriasis and psoriatic arthritis:
- Etanercept has been found to reduce the production and expression of TNF-alpha and its receptors in lesional and non-lesional skin samples of patients with psoriasis 5.
- Long-term efficacy and safety of etanercept in the treatment of psoriasis and psoriatic arthritis have been demonstrated in several studies 6.
Key Points
- Psoriatic myocarditis is a rare condition with limited treatment options.
- TNF-alpha inhibitors such as etanercept may be considered as a treatment option, but more research is needed to determine their efficacy and safety.
- Etanercept has been found to be safe and well-tolerated in patients with psoriasis and psoriatic arthritis, but caution should be exercised in patients with certain comorbidities.