Division of Rheumatology, Department of Medicine, Campus Box 8045, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
Rheum Dis Clin North Am. 2014 Feb;40(1):27-49. doi: 10.1016/j.rdc.2013.10.005. Epub 2013 Nov 5.
RA can manifest in a variety of cardiac complications, including pericarditis, valvular disease, cardiomyopathy, and amyloidosis. Subclinical involvement is higher than anticipated. CVD is also prevalent in patients with RA, with onset in early disease. Several disease-specific risk factors, like seropositivity, disease activity, and medications, are implicated in the pathogenesis of CVD in RA. Cardiovascular risk assessment in RA varies from the general population. Some traditional risk factors like BMI and lipid levels apply differently to the RA population. Statins are useful in managing dyslipidemia in RA. There is good evidence to support cardiovascular risk reduction with methotrexate and TNF-I use if good disease control is achieved.
类风湿关节炎可引起多种心脏并发症,包括心包炎、瓣膜病、心肌病和淀粉样变性。亚临床受累的发生率高于预期。类风湿关节炎患者也常并发心血管疾病,且疾病在早期即可发生。一些疾病特异性的危险因素,如血清阳性、疾病活动度和药物等,与类风湿关节炎患者心血管疾病的发病机制有关。类风湿关节炎患者的心血管风险评估与普通人群不同。一些传统的危险因素,如体重指数和血脂水平,在类风湿关节炎患者中应用时有所不同。他汀类药物可有效治疗类风湿关节炎患者的血脂异常。如果实现了良好的疾病控制,甲氨蝶呤和 TNF-I 的使用可显著降低心血管风险,这方面有充分的证据支持。