Pseudonormalization of the Typical Electrocardiography Repolarization Pattern of a Black Athlete.

Cardiac repolarization of black athletes has a distinctive pattern. During an episode of pericarditis, this pattern may evolve into a "pseudonormalized" electrocardiography (ECG). On resolution of the pericardial inflammation, the ECG may return to the normal variant for a black athlete, sounding the alarms of extended disease to the myocardium. Recognizing the normal variant for a black athlete will reduce the need for unnecessary further testing or treatments. The case is discussed in detail.

TRAF3IP2 gene and systemic lupus erythematosus: association with disease susceptibility and pericarditis development.

Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease. Although genetic factors confer susceptibility to the disease, only 15 % of the genetic contribution has been identified. TRAF3IP2 gene, associated with susceptibility to psoriatic arthritis and psoriasis, encodes for Act1, a negative regulator of adaptive immunity and a positive signaling adaptor in IL-17-mediated immune responses. The aim of this study was to assess the role of TRAF3IP2 gene variability in SLE susceptibility and disease phenotype in an Italian population. Two hundred thirty-nine consecutive SLE patients were enrolled. Study protocol included complete physical examination; the clinical and laboratory data were collected. Two hundred seventy-eight age- and ethnicity-matched healthy subjects served as controls. TRAF3IP2 polymorphisms (rs33980500, rs13190932, and rs13193677) were analyzed in both cases and controls. Genotype analysis was performed by allelic discrimination assays. A case-control association study and a genotype-phenotype correlation were performed. The rs33980500 and rs13193677 resulted significantly associated with SLE susceptibility (P = 0.021, odds ratio (OR) = 1.71, and P = 0.046, OR = 1.73, respectively). All three TRAF3IP2 single nucleotide polymorphisms resulted associated with the development of pericarditis; in particular, rs33980500 showed the strongest association (P = 0.002, OR 2.59). This association was further highlighted by binary logistic regression analysis. In conclusion, our data show for the first time the contribution of TRAF3IP2 genetic variability in SLE susceptibility, providing further suggestions that common variation in genes that function in the adaptive and innate arms of the immune system are important in establishing SLE risk. Our study also shows that this gene may affect disease phenotype and, particularly, the occurrence of pericarditis.

The impact of race and ethnicity on disease severity in systemic lupus erythematosus.

OBJECTIVES: Systemic lupus erythematosus (SLE) can result in comorbidities and high disease severity. The aim of this study was to evaluate the effects of age, sex, race, ethnicity, cost of hospitalization, length of stay, and payor source on SLE disease severity scores. DESIGN: Epidemiological study. SETTING: Hospital discharge data were obtained from the DFW Hospital Council (DFWHC), for 65,535 patients hospitalized in the North Texas Dallas-Fort Worth (DFW) Metropolitan Statistical Area (MSA) from 1999-2005 with at least one autoimmune disease. PATIENTS: Of the 65,535 autoimmune patients, 14,829 patients had SLE as a diagnosis. The sample was assessed for disease severity according to the SLE comorbidity Index. MAIN OUTCOME: Disease severity, SLE comorbidities. RESULTS: SLE patients were younger and more than five times more likely to have multiple autoimmune diseases. More than one third of Hispanic patients were on Medicaid or self-pay and more likely to have higher disease severity. Race (Caucasian), sex (female), and payor source (PPO/POS) predicted lower disease severity scores. SLE was predictive of eight of the fourteen SLE-CI diseases, with greatest effects observed for nephritis (OR = 3.30, P < .0001), chronic renal failure (OR = 3.36, P < .0001), pericarditis (OR = 3.2, P < .0001), and pleuritis (OR = 2.06, P < .0001). Non-Caucasian patients were more likely to have chronic renal failure, nephritis, congestive heart failure, pericarditis and pleuritis. CONCLUSIONS: The comorbidities that exist in SLE vary according to ethnicity. It is paramount for physicians to be cognizant of these disparities and make appropriate referrals.

Acute post-MI pericarditis.

The diagnosis of acute pericarditis may be difficult to establish in patients with recent transmural infarcts as the symptomatology frequently mimics the clinical presentation associated with recurrent ischemia. A careful assessment of the postmyocardial infarction patient may reveal the clinical and electrocardiographic features associated with developing pericarditis. Prompt and accurate recognition of this complication is critical in order to institute definitive therapy, minimize the risk of hemodynamic compromise, and provide psychological support.