Department of Rheumatology, Diakonhjemmet Hospital, PB.23 Vindern, N-0319 Oslo,
Ann Rheum Dis. 2011 May;70(5):812-7. doi: 10.1136/ard.2010.141523. Epub 2011 Feb 2.
To compare markers of cardiovascular disease (CVD) risk between patients with rheumatoid arthritis (RA) in an active disease state and those with RA in remission, and to compare both groups with community controls.
113 patients with RA and 86 community controls were assessed across a panel of biomarkers for CVD. RA in remission was defined as Clinical Disease Activity Index ≤2.8. Community controls were selected at random by Statistics Norway, and controls were matched with patients in the cohorts in strata using details of age, sex and residential area. A panel of biomarkers (N-terminal pro-brain natriuretic peptide (NT-proBNP), total cholesterol, reactive hyperaemia index (RHI), pressure measurements, measures of arterial stiffness and intima-media thickness) were compared between patients with active RA and those with RA in remission. Both groups were compared with controls. In addition, biomarker levels were compared across subgroups based on anticyclic citrullinated peptide status, level of joint destruction and presence of extra-articular manifestations.
Patients with active RA had significantly higher levels of NT-proBNP, brachial systolic pressure, augmentation index and central systolic pressure but lower cholesterol than patients in remission and controls. In addition, patients with active RA had significantly higher levels of pulse wave velocity and worse RHI than patients in remission. Comparison across other subgroups gave less consistent differentiations in levels of CVD risk markers.
Patients with active RA, but not those in remission, had significantly increased levels of CVD risk markers. These results link inflammatory activity to markers of CVD risk in patients with RA and may indirectly support the notion that remission in RA confers diminished cardiovascular morbidity.
比较处于活动期的类风湿关节炎（RA）患者与缓解期 RA 患者以及与社区对照者之间心血管疾病（CVD）风险标志物的差异。
对 113 例 RA 患者和 86 例社区对照者进行了 CVD 生物标志物的检测。RA 缓解期定义为临床疾病活动指数（CDAI）≤2.8。社区对照者由挪威统计局随机选择，对照者与队列中的患者按年龄、性别和居住区域在层内进行匹配。比较活动期 RA 患者与缓解期 RA 患者之间以及两组患者与对照者之间的生物标志物（N 端脑利钠肽前体（NT-proBNP）、总胆固醇、反应性充血指数（RHI）、血压测量、动脉僵硬度和内-中膜厚度）。另外，还根据抗环瓜氨酸肽状态、关节破坏程度和关节外表现的存在情况对亚组的生物标志物水平进行了比较。
与缓解期患者和对照者相比，活动期 RA 患者的 NT-proBNP、肱动脉收缩压、增强指数和中心收缩压显著升高，而胆固醇水平显著降低。此外，活动期 RA 患者的脉搏波速度明显升高，RHI 明显降低。其他亚组的比较结果在 CVD 风险标志物水平上的差异不那么一致。
处于活动期的 RA 患者而非缓解期患者的 CVD 风险标志物水平显著升高。这些结果将炎症活动与 RA 患者的 CVD 风险标志物联系起来，间接支持了 RA 缓解降低心血管发病率的观点。
