University of Debrecen Faculty of Medicine, Institute of Medicine, Department of Rheumatology, Hungary.
University of Debrecen Faculty of Medicine, Institute of Medicine, Department of Angiology, Debrecen, Hungary.
Autoimmun Rev. 2016 Jul;15(7):756-69. doi: 10.1016/j.autrev.2016.03.014. Epub 2016 Mar 12.
Autoimmune-inflammatory rheumatic diseases, such as rheumatoid arthritis (RA) have been associated with autoimmune atherosclerosis leading to increased cardiovascular risk. Traditional risk factors, genetics, as well as the role of systemic inflammation including inflammatory cells, cytokines, chemokines, proteases, autoantibodies, adhesion receptors and others have been implicated in the development of these vascular pathologies. Cardiovascular risk may be determined by the use of currently available tools. In addition, non-invasive assessment of vascular pathophysiology by imaging, as well as laboratory biomarkers can help to refine risk assessment. With respect to prevention and therapy, traditional vasculoprotection using statins, ACE inhibitors, aspirin should be applied to patients at risk. Non-steroidal antiinflammatory drugs and corticosteroids may be pro-atherogenic, on the other hand, they may also be beneficial due to their anti-inflammatory nation. Traditional and biologic DMARDs may have significant vascular and metabolic effects. Decreasing inflammatory activity by any of these agents may lead to better CV outcome. The official EULAR recommendations on the assessment and management of cardiovascular disease in arthritides may guide the rheumatologist during the process of CV screening, prevention and treatment.
自身免疫性炎症性风湿病，如类风湿关节炎（RA），与自身免疫性动脉粥样硬化有关，导致心血管风险增加。传统的危险因素、遗传因素，以及包括炎症细胞、细胞因子、趋化因子、蛋白酶、自身抗体、黏附受体等在内的全身炎症在这些血管病变的发展中起作用。可以使用目前可用的工具来确定心血管风险。此外，通过影像学和实验室生物标志物对血管病理生理学进行非侵入性评估，也有助于完善风险评估。关于预防和治疗，应将他汀类药物、ACE 抑制剂、阿司匹林等传统血管保护剂应用于高危患者。非甾体抗炎药和皮质类固醇可能具有促动脉粥样硬化作用，但由于其抗炎作用，也可能有益。传统和生物 DMARDs 可能对血管和代谢有显著影响。这些药物中的任何一种降低炎症活性都可能导致更好的 CV 结果。EULAR 关于关节炎中心血管疾病评估和管理的官方建议可能会在 CV 筛查、预防和治疗过程中指导风湿病学家。
