Ruscitti Piero, Margiotta Domenico Paolo Emanuele, Macaluso Federica, Iacono Daniela, D'Onofrio Francesca, Emmi Giacomo, Atzeni Fabiola, Prete Marcella, Perosa Federico, Sarzi-Puttini Piercarlo, Emmi Lorenzo, Cantatore Francesco Paolo, Triolo Giovanni, Afeltra Antonella, Giacomelli Roberto, Valentini Gabriele
Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila Clinical Medicine and Rheumatology Department, Campus Bio-Medico University of Rome, Rome Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples Rheumatology Section, Department of Medical and Surgical Sciences, University of Foggia Medical School, Foggia Department of Experimental and Clinical Medicine, University of Florence, Florence Rheumatology Section, L. Sacco University Hospital, Milan Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
Medicine (Baltimore). 2017 Oct;96(42):e8180. doi: 10.1097/MD.0000000000008180.
Several studies have pointed out a significant association between rheumatoid arthritis (RA) and accelerated atherosclerosis. At the best of our knowledge, no such study has been carried out in a large Italian series and, in this study, we aimed to investigate the prevalence of both subclinical atherosclerosis and history of cardiovascular events (CVEs), in patients consecutively admitted from January 1, 2015 to December 31, 2015 to Rheumatology Units throughout the whole Italy.Centers members of GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) were invited to enrol patients consecutively admitted from January 1, 2015 to December 31, 2015 and satisfying American College of Rheumatology/ European League Against Rheumatism criteria for RA and to investigate each of them for: traditional cardiovascular risk factors: sex, age, smoking habit, total cholesterol, triglycerides, glycaemia, high blood pressure, metabolic syndrome (MS), type 2 diabetes (T2D); RA features: disease duration as assessed from the first symptom, disease activity as evaluated by DAS28, radiographic damage as assessed by hands and feet x-ray, and previous joint surgery; prevalence of both subclinical atherosclerosis and history of CVEs.Eight centers participated to the study. From January 1, 2015 to December 31, 2015, the 1176 patients, who had been investigated for all the items, were enrolled in the study. They were mostly women (80.52%), with a median age of 60 years (range, 18-91 years), a median disease duration of 12 years (range, 0.8-25 years), seropositive in 69.21%. Nineteen percent were in remission; 17.51% presented low disease activity; 39.45% moderate disease activity; 22.61% high disease activity.Eighty-two patients (6.9%) had a history for CVEs (58 myocardial infarction, 38 heart failure, 10 ischemic transitory attack, and 7 stroke). This figure appears to be lower than that reported worldwide (8.5%). After excluding the 82 patients with a history of CV events, subclinical atherosclerosis was detected in 16% of our patients, (176 patients), a figure lower than that reported worldwide (32.7%) and in previous Italian studies.This is the first Italian multicenter study on subclinical and clinical atherosclerosis in patients with RA. We pointed out a low prevalence of both subclinical atherosclerosis and history of CV events.
多项研究指出类风湿关节炎（RA）与动脉粥样硬化加速之间存在显著关联。据我们所知，尚未在大量意大利患者队列中开展此类研究。在本研究中，我们旨在调查2015年1月1日至2015年12月31日期间连续入住意大利各地风湿病科的患者中亚临床动脉粥样硬化和心血管事件（CVE）病史的患病率。邀请意大利临床与实验风湿病研究组（GIRRCS）的中心成员纳入2015年1月1日至2015年12月31日期间连续入住且符合美国风湿病学会/欧洲抗风湿病联盟RA标准的患者，并对每位患者进行以下调查：传统心血管危险因素：性别、年龄、吸烟习惯、总胆固醇、甘油三酯、血糖、高血压、代谢综合征（MS）、2型糖尿病（T2D）；RA特征：自首次症状起评估的疾病持续时间、通过DAS28评估的疾病活动度、通过手足X线评估的影像学损伤以及既往关节手术史；亚临床动脉粥样硬化和CVE病史的患病率。八个中心参与了该研究。2015年1月1日至2015年12月31日期间，对所有项目均进行了调查的1176例患者被纳入研究。他们大多为女性（80.52%），中位年龄为60岁（范围18 - 91岁），中位疾病持续时间为12年（范围0.8 - 25年），69.21%为血清阳性。19%处于缓解期；17.51%疾病活动度低；39.45%疾病活动度中等；22.61%疾病活动度高。82例患者（6.9%）有CVE病史（58例心肌梗死、38例心力衰竭、10例缺血性短暂发作和7例中风）。这一数字似乎低于全球报告的数字（8.5%）。在排除82例有CV事件病史的患者后，我们的患者中有16%（176例患者）检测到亚临床动脉粥样硬化，这一数字低于全球报告的数字（32.7%）以及之前意大利研究中的数字。这是意大利第一项关于RA患者亚临床和临床动脉粥样硬化的多中心研究。我们指出亚临床动脉粥样硬化和CV事件病史的患病率较低。
