Cardio-rheumatology clinics: The next logical progression in our field
This month, our featured roundtable explores the evolution and progress of a rapidly emerging interdisciplinary clinical model — the cardio-rheumatology clinic. In these collaborative settings, rheumatologists, cardiologists and other cardiovascular specialists work together to deliver integrated care, advance research and foster education.
I would like to extend my heartfelt gratitude to our contributors — Luigi Adamo, MD; Joshua F. Baker, MD; Julie J. Paik, MD, MHS; Heba Wassif, MD, MPH; and Brittany Nicole Weber, MD, PhD — who have generously shared their insights and expertise in this exciting and dynamic field. Over the years, I’ve highlighted various interdisciplinary partnerships in this column, from rheum-derm and rheum-GI, to rheum-ID and beyond. Clearly, the landscape of such collaborations is vast and continually expanding.
As our field evolves, I firmly believe that rheumatology stands out as one of the most inherently interdisciplinary specialties, especially when addressing complex disease states. The potential for growth in collaborative models is immense, and we will undoubtedly continue to witness their proliferation as health care moves toward more integrated, patient-centered approaches.
Until recently, the primary focus of rheumatology-cardiology collaborations has largely centered on cardiovascular disease prevention. This focus makes sense, given that many of our inflammatory diseases — such as rheumatoid arthritis, psoriatic arthritis and lupus — are well-documented accelerators of cardiovascular risk. At a minimum, it has been emphasized that although rheumatologists may not be directly responsible for prescribing pharmacologic therapies for cardiovascular disease prevention (eg, statins), we play a critical role in identifying high-risk patients and ensuring that appropriate pharmacologic and non-pharmacologic interventions are implemented by our primary care colleagues or cardiovascular specialists. I have no doubt that this aspect of our practice will continue to grow and evolve.
Our roundtable discussion highlights the rapidly evolving area of collaboration in managing diseases that can lead to direct myocardial toxicity, such as EGPA, Kawasaki disease, IgG4-related disease, sarcoidosis and more. These conditions now involve highly specialized diagnostic and assessment modalities that require the expertise of interventional cardiologists, including endomyocardial biopsy procedures, as well as cardiovascular pathologists for their interpretation.
At the same time, the field of cardiac imaging has made remarkable strides and has grown into its own distinct subspecialty, further emphasizing the need for interdisciplinary collaboration. Another important area of cooperation between our specialties is the exchange of knowledge regarding targeted and advanced immunotherapies. These therapies, which are increasingly being applied to inflammatory and infiltrative cardiac diseases, are a domain where we, as rheumatologists, have significant expertise to contribute with regard to optimizing the use of these agents.
On a personal note, Cassandra Calabrese, DO, and I were quickly immersed in the evolving field of rheumatology-cardiology about a decade ago when we began encountering a new, often devastating clinical entity known as myocarditis, frequently accompanied by inflammatory myopathy and myasthenia gravis, all in the context of cancer treatment with checkpoint inhibitors. Despite its initial rarity and clinical novelty, we were fortunate to have the incredible collaboration of our world-class cardio-oncology specialists at our cardiovascular institute. Their expertise has been invaluable, and we’ve learned so much from them ever since.
Reflecting on this emerging collaboration, it reminds me of how our specialty is on a never-ending journey. We are fortunate to be the inquisitive travelers on this path, joined by an ever-growing number of partners. That’s my perspective for now. What’s yours? Please share your thoughts with me at calabrl@ccf.org, rheumatology@healio.com or on X (formerly Twitter) at @LCalabreseDO.
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- Leonard H. Calabrese, DO, is the Chief Medical Editor, Healio Rheumatology, and Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic.
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