Rheumatology Division, Hospital de La Princesa, IIS-IP, Universidad Autónoma de Madrid (UAM), c/ Diego de León 62, 28006 Madrid, Spain.
Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Reade P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
Best Pract Res Clin Rheumatol. 2016 Oct;30(5):851-869. doi: 10.1016/j.berh.2016.10.006. Epub 2016 Nov 9.
Chronic inflammatory rheumatic diseases (IRD), including rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis, are prevalent conditions worldwide, with a considerable burden on healthcare systems. They are associated with increased cardiovascular (CV) morbidity and mortality. In this review, we focused on the epidemiology, traditional CV risk factors, genetics, and the link between chronic inflammation, atherosclerosis, and CV disease. Remarkably, patients with IRD have higher vulnerability to atheromatous plaques. The risk of unstable plaques is higher in patients with rheumatoid arthritis than in controls. Active disease is a characteristic ascribed to vulnerability and rupture of plaques and a cause of thrombosis in IRD. Management of CV risk in patients with IRD includes optimal control of disease activity. CV risk stratification by applying risk charts is also essential. Imaging techniques might be useful to determine the actual CV risk of patients with IRD who are included in the category of intermediate or moderate CV risk.
慢性炎症性风湿性疾病(IRD),包括类风湿关节炎、强直性脊柱炎和银屑病关节炎,是全球普遍存在的疾病,给医疗保健系统带来了相当大的负担。它们与心血管(CV)发病率和死亡率的增加有关。在这篇综述中,我们重点关注了流行病学、传统 CV 风险因素、遗传学以及慢性炎症、动脉粥样硬化和 CV 疾病之间的联系。值得注意的是,IRD 患者更容易出现动脉粥样硬化斑块。与对照组相比,类风湿关节炎患者的不稳定斑块风险更高。活动性疾病是易损性和斑块破裂的特征,也是 IRD 中血栓形成的原因。IRD 患者的 CV 风险管理包括疾病活动的最佳控制。通过应用风险图表进行 CV 风险分层也很重要。影像学技术可能有助于确定处于中危或高危 CV 风险类别中的 IRD 患者的实际 CV 风险。