The Link Between Congenital Heart Block and Autoimmune Disease

Congenital Heart Block (CHB) is a rare but serious condition that occurs more frequently in newborns born to mothers with autoimmune disease. Image courtesy of Insider.com.

What is Congenital Heart Block?

According to the National Organization for Rare Disease, Congenital Heart Block, or CHB for short, is the interference of the transfer of electric nerve impulses that regulate the pumping of the heart muscle.

As long as electrical impulses are transmitted normally between the heart’s chambers – the atria and the ventricles – the heart contracts normally, allowing for blood to be pumped throughout the body. If the transmission of the signal is impeded, the blocked electrical transmission is known as heart block, or atrioventricular (AV) block.

Though heart block can happen to anyone of any age, it is called congenital heart block if it occurs in a fetus or newborn up to 28 days old.

Why Does CHB Occur in Children Born to Women with Autoimmune Disease?

Autoimmune-associated CHB has been found in a variety of maternal autoimmune disorders, including Sjogren’s syndrome, systemic lupus erythematosus, rheumatoid arthritis, antiphospholipid syndrome (APS), mixed connective tissue disorders, and undifferentiated connective tissue disease.

It is believed that CHB may result when maternal antibodies cross the placenta, enter the fetus, and attack the fetal cardiac conduction system. The antibodies that were originally produced by the mother’s body to fight infections mistakenly recognize parts of the fetal heart’s conduction system as foreign; for this reason, the immune system attacks and damages the tissues, resulting in inflammation and scarring, which in turn leads to faulty conduction. 

What Is the Risk of Congenital Heart Block if I Have an Autoimmune Disease?

A 2017 study conducted by Chinese medical professionals Kai-Yu Zhou and Yi-Min Hua of the West China Second University Hospital, Department of Pediatric Cardiology, revealed that more than half of CHB cases (between 60 and 90%) are associated with maternal autoimmune disease.

Among the general population, CHB occurs in 1 out of every 20,000 live births – an incidence of only 0.00005%. The study found that autoimmune-associated CHB, however, occurs at much more frequent rates, affecting between 2–5% pregnancies with positive anti-Ro/SSA and La/SSB antibodies. The study also found that when a woman had a child with CHB, the recurrence rate of CHB was 12–25% for a subsequent pregnancy.

Mortality Rate & Treatment for Congenital Heart Block

The perinatal mortality rate of a newborn with CHB is up to 30%, and even higher in the presence of endocardial fibroelastosis (EFE) or dilated cardiomyopathy (DCM), which are other potential complications associated with CHB.

If CHB is detected in utero by a fetal electrocardiography (ECG) and echocardiography, your OB/GYN may prescribe an adrenocorticosteroid such as dexamethasone, which works to decrease inflammation and the number of circulating maternal antibodies in the fetus.

Once born, other studies have shown that between that 64 and 70% of CHB survivors require surgery to permanently implant a pacemaker, a medical device which stimulates the heart to contract so that it can pump blood.

How to Prevent Congenital Heart Block

A 2016 report by the American College of Rheumatology states that there are no official guidelines about the prevention, screening, and treatment of CHB due to maternal Ro antibodies.

However, in the same report, it was stated that in a survey of 330 women with autoimmune conditions, 67% were told by their rheumatologists to use hydroxychloroquine (also known as Plaquenil) to prevent CHB. In addition, 62% were told to start the drug prior to pregnancy, in order to prevent the condition from developing.

Another study published in The Journal of the American College of Cardiology stated that hydroxychloroquine reduces the recurrence of CHB below the historical rate by more than 50%, further demonstrating the promise of this drug in the prevention of CHB.

Have you or someone you love been affected by congenital heart block (CHB)? Let us know in the comments below!

Autoimmune Disease & Peripheral Neuropathy

Peripheral Neuropathy is a common complaint among autoimmune patients. Image courtesy of the Southern Regional Pain Services.

Did you know that autoimmune disease can cause debilitating nerve pain and other nervous system difficulties?

Many medical professionals are unaware that autoimmune conditions can cause a variety of neurological symptoms, or neuropathies, in patients. Though it is commonly known that autoimmune diseases are responsible for joint pain and other kinds of inflammation, nerve pain is often overlooked.

According to the National Institute of Neurological Disorders and Stroke, peripheral neuropathy refers to conditions that involve damage to the peripheral nervous system, which is the vast communication network that sends signals between the central nervous system (the brain and spinal cord) and other parts of the body. Research has shown that over 20 million Americans suffer from some form of peripheral neuropathy, of which there are over 100 known unique types!

How can autoimmune disease cause peripheral neuropathy?

Systemic autoimmune diseases that impact the entire body can cause peripheral neuropathy because of the impact these diseases have on one’s nerves. Conditions like Type 1 diabetes, lupus, Sjogren’s syndrome, and rheumatoid arthritis can all cause nerves to become compressed or entrapped as a result of inflamed surrounding tissues.

Some autoimmune diseases aren’t systemic, or body-wide, but rather, target the nervous system directly. For example, in autoimmune conditions like Guillain-Barre, multiple sclerosis (MS) and chronic inflammatory demyelinating polyneuropathy (CIDP), the immune system may go after the motor nerves, motor fibers, or the myelin sheath coating the nerves. In other instances, the small fibers are attacked, resulting in ongoing chronic pain.

How does peripheral neuropathy manifest?

Peripheral neuropathies can manifest for different people in different ways. For example, rather than a sharp, jabbing, throbbing pain, for some patients it may feel more like prickling, tingling, burning, numbness, or even a complete loss of sensation.

According to the Mayo Clinic, peripheral neuropathy can also make you feel like you’re having a sensation that you’re not; for example, feeling like you’re wearing gloves or socks when you’re not. Peripheral neuropathies can also cause you to feel pain for activities that you know shouldn’t cause pain, such as pain in your feet after they’re underneath a blanket.

What you can do about your autoimmune nerve pain

Medical Interventions

If you have autoimmune nerve pain, don’t suffer in silence. Talk to your primary care physician and see if they can refer you to a neurologist or chronic pain specialist. From there, your physician can help put together a treatment plan to ease your pain.

I have Sjogren’s syndrome and for a period of 7+ years, chronic pain was a regular part of my life. My rheumatologist prescribed me all kinds of joint pain medications, from plaquenil (generic name: hydroxychloroquine) an anti-malarial drug, to prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs), steroid medications, and even chemotherapies! It wasn’t until my pain was identified as nerve pain, not joint pain, that I was able to switch to a medication that worked to reduce my peripheral neuropathy.

In addition, I worked with a neurologist to determine that I had a co-morbid condition, called benign fasciculation syndrome, which was also contributing to my pain. This is important, because many chronic pain sufferers have co-morbidities, like fibromyalgia, which can increase your pain levels or even be the real driving force behind it.

Lifestyle Considerations

Beyond medications, your lifestyle is also an important component of reducing your neuropathic pain. Vitamin deficiencies, for example, have been identified as a cause of peripheral neuropathies. This is because certain B vitamins, including vitamins B1, B6 and B12, as well as vitamin E and niacin, are crucial for maintaining nerve health. Since alcoholism can result in serve vitamin deficiencies, avoiding substance abuse is also key.

Exposure to certain toxins or poisonous substances, such as lead and mercury, can also impact your nerves and cause resulting pain. Finally, trauma and pressure on the nerves can cause neuropathies as well, so alleviating pressure on your nerves, such as decreasing repeated motions on the parts of your body experiencing pain, is important.

Do you have an autoimmune condition(s) and suffer from peripheral neuropathy? What do you do to cope with your chronic pain? Let us know in the comments below!

Baby with Rare Autoimmune Disease Seeks Stem Cell Donor

Boston De Castro smiles while in care of the Children's Hosptial
Boston De Castro has a rare autoimmune blood disease called HLH, and he desperately needs a matching stem cell donor to save his life.

A three-month old baby boy named Boston De Castro from Winnipeg, Manitoba, Canada is seeking a stem cell donor.

Boston suffers from a rare autoimmune disease called hemophagocytic lymphohistiocytosis, known as HLH for short. According to Cincinnati Children’s Hospital, HLH is a life-threatening autoimmune condition in which the immune system’s T and NK cells become overactive, causing damaging inflammation to the body’s tissues and internal organs. The condition is especially damaging to the liver, brain and bone marrow, where blood is made.

Symptoms of HLH include persistent fevers, rash, enlarged liver and spleen, anemia, low platelets and white blood cells, jaundice, hepatitis, liver failure, respiratory issues, seizures, and altered mental functions. Patients need to undergo blood transfusions, stem cell therapy and a bone marrow transplant, in addition to taking various medications to calm the immune system, including steroids and chemotherapy.

Boston first started experiencing symptoms only a few weeks ago, when he developed a fever, and then his liver and spleen became enlarged. Shortly after, his blood counts started dropping rapidly. This is when he received a bone marrow biopsy, and was diagnosed with HLH. The three-month-old is currently undergoing his first round of chemotherapy while his parents desperately seek a stem cell donor that can save his life. The added challenge, however, is finding a matching stem cell donor that is of mixed ethnicity like him – half-Caucasian and half-Filipino.

His mother, Simone Janetta, spoke to the Canadian Broadcasting Corporation (CBC), saying, “We are just begging the community. Anybody who is half-Filipino [and] half-Caucasian, even if you’re any other ethnic minority, just get on the stem cell registry. You could safe a life, just like our son’s.”

Simone Janetta with her son Boston De Castro
Boston’s mother, Simon Janettta, holds her son while her undergoes chemotherapy. Their family is living in hospital to ensure Boston receives round-the-clock medical care.

Her plea was heard not only by the CBC, but by the Prime Minister of Canada himself, Justin Trudeau, who took to social media to share Boston’s story. “Can you save Boston’s life? There are two ways you can help: If you’re half-Caucasian and half-Filipino, please reach out to Canadian Blood Services and see how you can become a stem cell donor. If you aren’t you can still share this story and spread the word.” The post has received over 23,000 likes and 11,000 shares on Facebook already.

Donors must be between 17-35 years of age, with a preference for males, to reduce post-transplant complications. According to the Canadian Blood Services, only 3.5% of stem cell donors in the database are of mixed ethnic background. Because HLH is believed to be genetic, the donor must be unrelated to Boston as well.

Boston’s father, Rex De Castro, added, “I’m kindly begging anyone with a mixed-race ethnicity to donate their stem cells to help my son survive. The chemotherapy and the steroids [are] a temporary fix, and he needs the stem cell transplant really bad.”

Rex De Castro holds his two children
Rex De Castro, Boston’s dad, cuddles his 2-year-old daughter, Beatrix and newborn son, Boston. Both Beatrix and Boston suffer from rare health conditions.

A GoFundMe page has been setup for Boston, which has garnered over $25,000 in donations thus far. The donated funds will be used to relieve some of the monetary stress associated with the De Castro family having to live in hospital, and also, towards the bone marrow match. Many people have posted encouraging words on Boston’s GoFundMe page, urging him and his family to stay strong.

To learn more about HLH, check out this YouTube video by the Cincinnati Children’s Hospital. To read more about Boston De Castro’s story, check out his story on the CBC news website. And, if you know anyone who could potentially be a stem cell match for Boston or other mixed ethnicity patients, please consider sharing this story with them; you could save a life.