#4-86E. Unveiling the Hidden Threat: Cardiac Involvement in Systemic Sclerosis (Rheumatology, 2026)

Are we missing a hidden, potentially lethal cardiac complication that profoundly dictates the prognosis of our patients with systemic sclerosis? This episode explores the complex pathophysiology, clinical manifestations, and management of primary heart involvement in systemic sclerosis (SSc-PHI). The comprehensive review elaborates on how vascular and immune-mediated inflammatory pathways, compounded by fibrotic cytokines, synergize to cause devastating conditions such as myocardial fibrosis, myocarditis, and arrhythmias. The most crucial clinical takeaway is the pivotal role of cardiovascular magnetic resonance (CMR) imaging in the early, non-invasive detection of subclinical cardiac involvement, offering a crucial window for timely intervention and prognostic assessment. However, when critically appraising this review, clinicians must remain cautious, as the current evidence base for targeted SSc-PHI treatments still relies heavily on small case series and observational cohorts rather than large randomized controlled trials. For practicing physicians, leveraging these early screening tools is paramount for precise risk stratification. It underscores the urgent necessity of proactive, multidisciplinary collaboration between rheumatologists and cardiologists to enhance early diagnostic strategies and significantly improve survival outcomes in daily clinical practice.

Citation: Soo CY, Jex N, Bissell LA, Del Galdo F, Plein S. Cardiac involvement in systemic sclerosis: mechanisms, manifestations and management. Rheumatology. 2026. DOI: https://doi.org/10.1093/rheumatology/keag064

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.