Arida Aikaterini, Protogerou Athanasios D, Konstantonis George, Fragiadaki Kalliopi, Kitas George D, Sfikakis Petros P
Rheumatology Unit, 1st Department of Propaedeutic Internal Medicine, Laikon Hospital, National and Kapodistrian Univeristy of Athens.
Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School, Greece.
Rheumatology (Oxford). 2017 Jun 1;56(6):934-939. doi: 10.1093/rheumatology/kew506.
RA associates with increased cardiovascular disease (CVD) morbidity and mortality due to accelerated atherosclerosis, attributed to both classical risk factors and chronic inflammation. The aim of this study was to test the hypothesis that effective disease control over 3 years modifies acceleration of atherosclerosis in RA.
Consecutive, non-diabetic RA patients previously examined by ultrasonography for subclinical atherosclerosis were re-evaluated after 3.2 (0.2) years, provided that they were in remission/low disease activity (DAS28 <3.2) for at least 75% of this period. Patients (n = 139) were demographically matched with 139 non-diabetic, non-RA control individuals studied in parallel.
Patients and controls (mean age of 56 years at baseline) had a comparable burden of classical CVD risk factors. Patients' pulse wave velocity (reflecting arterial stiffness) changed by 0.07 m/s/year and left carotid intima-media thickness (reflecting wall hypertrophy) increased by 0.009 mm/year; formation of new atheromatic plaques in carotid and/or femoral arterial beds occurred in 22%. Multivariate analysis after correcting for all classical CVD risk factors and anti-hypertensive/lipid-lowering therapies demonstrated no significant differences between patients and controls in any of the subclinical atherosclerosis indices. Changes in all atherosclerosis indices from baseline to end of follow-up were comparable between those 56 patients treated with biologic DMARDs and their demographically matched patients treated with synthetic DMARDs.
Effective disease control may abrogate any RA-specific effect on the progression of atherosclerosis regardless of treatment. Whether early and sustained RA control translates to the CVD outcomes expected in the general population should be examined in prospective studies.
类风湿性关节炎（RA）与心血管疾病（CVD）发病率和死亡率增加相关，这是由于动脉粥样硬化加速所致，其归因于经典危险因素和慢性炎症。本研究的目的是检验以下假设：3年的有效疾病控制可改变RA患者动脉粥样硬化的加速进程。
连续纳入之前通过超声检查评估亚临床动脉粥样硬化的非糖尿病RA患者，在3.2（0.2）年后重新评估，前提是他们在这段时间内至少75%处于缓解期/低疾病活动度（疾病活动度评分28关节计数法（DAS28）<3.2）。患者（n = 139）在人口统计学上与139名同时研究的非糖尿病、非RA对照个体相匹配。
患者和对照组（基线时平均年龄56岁）具有相当的经典CVD危险因素负担。患者的脉搏波速度（反映动脉僵硬度）每年变化0.07 m/s，左颈动脉内膜中层厚度（反映血管壁肥厚）每年增加0.009 mm；22%的患者在颈动脉和/或股动脉床出现新的动脉粥样硬化斑块。在校正所有经典CVD危险因素和抗高血压/降脂治疗后进行的多变量分析显示，患者和对照组在任何亚临床动脉粥样硬化指标上均无显著差异。在56例接受生物性改善病情抗风湿药物（DMARDs）治疗的患者及其在人口统计学上匹配的接受合成DMARDs治疗的患者中，从基线到随访结束时所有动脉粥样硬化指标的变化相当。
有效的疾病控制可能消除RA对动脉粥样硬化进展的任何特异性影响，无论采用何种治疗方法。早期和持续的RA控制是否能转化为普通人群预期的CVD结局，应在前瞻性研究中进行检验。
