title: A patient with Leiden V mutation, multiple sclerosis, psoriasis, and sicca syndrome: could celecoxib and fingolimod adversely affect the heart?
abstract: The paper describes the case of a patient affected by a combination of genetic and autoimmune diseases (multiple sclerosis, psoriatic arthritis, Leiden V mutation, and sicca syndrome) and hypertension. The psoriatic arthritis was treated with celecoxib and multiple sclerosis with fingolimod. The patient developed high fever and endocarditis, resulting in severe mitral regurgitation, atrial fibrillation, and congestive heart failure. Evidence is suggestive of adverse effects of potent immunosuppressive and anti-inflammatory therapies with biologic agents and the cardiovascular system. Fingolimod increases susceptibility to infections and induced endocarditis resulting in severe mitral regurgitation, atrial fibrillation, and congestive heart failure. Managed care systems limit the contact among basic care physicians and specialists. However, the process by which the optimal decision may be reached for a patient with a complex pathology is shared decision making, where the risk of severe complications and medical expenses may be reduced.
authors.affiliation: Cardiology Office, Marktgasse 10A, 4310 Rheinfelden, Switzerland. praxis@cocco.ch
authors.forename: G
authors.initials: G
authors.lastname: Cocco
mesh_terms: D015535:Arthritis, Psoriatic / Q000150:complications / Q000188:drug therapy* / Q000235:genetics; D001281:Atrial Fibrillation / Q000139:chemically induced; D001327:Autoimmune Diseases / Q000150:complications / Q000188:drug therapy* / Q000235:genetics; D000068579:Celecoxib; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005165:Factor V / Q000235:genetics*; D000068876:Fingolimod Hydrochloride; D006321:Heart / Q000187:drug effects / Q000503:physiopathology; D006331:Heart Diseases / Q000139:chemically induced* / Q000503:physiopathology; D006333:Heart Failure / Q000139:chemically induced; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000235:genetics; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000139:chemically induced; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy / Q000235:genetics; D009154:Mutation; D009206:Myocardium / Q000473:pathology; D011409:Propylene Glycols / Q000009:adverse effects*; D011720:Pyrazoles / Q000009:adverse effects*; D012859:Sjogren's Syndrome / Q000150:complications / Q000188:drug therapy / Q000235:genetics; D013110:Sphingosine / Q000009:adverse effects / Q000031:analogs & derivatives*; D013449:Sulfonamides / Q000009:adverse effects*
chemical_list: D016861:Cyclooxygenase Inhibitors; D007166:Immunosuppressive Agents; D011409:Propylene Glycols; D011720:Pyrazoles; D013449:Sulfonamides; C095381:factor V Leiden; D005165:Factor V; D000068876:Fingolimod Hydrochloride; D000068579:Celecoxib; D013110:Sphingosine