Division of Rheumatology and Clinical Immunology, University of Split School of Medicine, University Hospital Centre Split, Šižgorićeva 20/II, 21 000, Split, Croatia.
Clin Rheumatol. 2013 Jul;32(7):937-42. doi: 10.1007/s10067-013-2273-8. Epub 2013 May 7.
The vasculature plays a crucial role in inflammation and atherosclerosis associated with the pathogenesis of rheumatoid arthritis. Vasculitis in rheumatoid arthritis is associated with longstanding disease, has an important impact on a patient's quality of life and influences patient life expectancy. Seropositivity, specific human leukocyte antigen variations, antibodies to cyclic citrullinated peptides, and cigarette smoking are among the genetic and environmental predictors of rheumatoid vasculitis. Atherosclerosis is an early and common finding in rheumatoid arthritis and it correlates with disease duration, activity, and severity. Apart from conventional risk factors such as cigarette smoking, physical inactivity, obesity, arterial hypertension, dyslipidemia and diabetes mellitus, rheumatoid arthritis-related risk factors including disease duration, severity and activity, rheumatoid factor and antibodies to cyclic citrullinated peptides status, functional impairment, C-reactive protein, radiographic changes, presence of the shared epitope, and treatment modalities are all implicated in the development of accelerated atherosclerosis. Atherosclerosis is also considered an inflammatory disease; thus, it may share common pathogenic mechanisms with rheumatic diseases such as rheumatoid arthritis. Advances in treatment of rheumatoid arthritis with disease-modifying biologic and nonbiologic agents will probably continue to reduce the incidence of vasculitis. Since the goal of treatment for rheumatoid arthritis is to decrease inflammatory burden, successful treatment may theoretically reduce the risk of accelerated atherosclerosis.
脉管系统在与类风湿关节炎发病机制相关的炎症和动脉粥样硬化中起着关键作用。类风湿关节炎中的脉管炎与长期疾病有关，对患者的生活质量有重要影响，并影响患者的预期寿命。血清阳性、特定人类白细胞抗原变异、环状 citrullinated 肽抗体和吸烟是类风湿关节炎血管炎的遗传和环境预测因素之一。动脉粥样硬化是类风湿关节炎的早期和常见表现，它与疾病持续时间、活动度和严重程度相关。除了吸烟、缺乏运动、肥胖、动脉高血压、血脂异常和糖尿病等常规危险因素外，类风湿关节炎相关的危险因素包括疾病持续时间、严重程度和活动度、类风湿因子和环状 citrullinated 肽抗体状态、功能障碍、C 反应蛋白、放射学改变、共享表位的存在以及治疗方式都与加速动脉粥样硬化的发生有关。动脉粥样硬化也被认为是一种炎症性疾病；因此，它可能与类风湿关节炎等风湿性疾病共享共同的发病机制。随着疾病修饰性生物和非生物制剂治疗类风湿关节炎的进展，血管炎的发病率可能会继续降低。由于类风湿关节炎治疗的目标是减轻炎症负担，因此理论上成功的治疗可能会降低加速动脉粥样硬化的风险。
