Winthrop Research Institute, Department of Medicine, NYU Winthrop Hospital, 101 Mineola Boulevard, Suite 4-004, Mineola, NY 11501, United States.
Curr Pharm Des. 2019;25(9):969-986. doi: 10.2174/1381612825666190430113212.
Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disorder that increases the risk of developing cardiovascular disease. There is accumulating evidence that the RA disease state accelerates the formation of atherosclerotic plaques. Treatments for RA improve joint symptomatology and may reduce inflammation, but consideration of their effects on the cardiovascular system is generally low priority.
Since cardiovascular disease is the leading cause of mortality in RA patients, the impact of RA therapies on atherosclerosis is an area in need of attention and the focus of this review.
The drugs used to treat RA may be analgesics, conventional disease-modifying anti-rheumatic drugs, and/or biologics, including antibodies against the cytokine tumor necrosis factor-α. Pain relievers such as nonselective non-steroidal anti-inflammatory drugs and cyclooxygenase inhibitors may adversely affect lipid metabolism and cyclooxygenase inhibitors have been associated with increased adverse cardiovascular events, such as myocardial infarction and stroke. Methotrexate, the anchor disease-modifying anti-rheumatic drug in RA treatment has multiple atheroprotective advantages and is often combined with other therapies. Biologic inhibitors of tumor necrosis factor-α may be beneficial in preventing cardiovascular disease because tumor necrosis factor-α promotes the initiation and progression of atherosclerosis. However, some studies show a worsening of the lipid profile in RA with blockade of this cytokine, leading to higher total cholesterol and triglycerides.
Greater understanding of the pharmacologic activity of RA treatments on the atherosclerotic process may lead to improved care, addressing both damages to the joints and heart.
类风湿关节炎（RA）是一种慢性系统性自身免疫性炎症性疾病，会增加患心血管疾病的风险。越来越多的证据表明，RA 疾病状态会加速动脉粥样硬化斑块的形成。RA 的治疗方法可改善关节症状，并可能减轻炎症，但通常对其对心血管系统的影响重视程度较低。
由于心血管疾病是 RA 患者死亡的主要原因，因此 RA 治疗方法对动脉粥样硬化的影响是一个需要关注的领域，也是本次综述的重点。
用于治疗 RA 的药物可能是镇痛药、传统的疾病修饰抗风湿药物和/或生物制剂，包括针对细胞因子肿瘤坏死因子-α的抗体。镇痛药，如非选择性非甾体抗炎药和环氧化酶抑制剂，可能会对脂质代谢产生不利影响，而环氧化酶抑制剂与增加不良心血管事件（如心肌梗死和中风）有关。甲氨蝶呤是 RA 治疗中的主要疾病修饰抗风湿药物，具有多种动脉保护作用，通常与其他疗法联合使用。肿瘤坏死因子-α的生物抑制剂可能有益于预防心血管疾病，因为肿瘤坏死因子-α可促进动脉粥样硬化的发生和进展。然而，一些研究表明，阻断这种细胞因子会导致 RA 的血脂谱恶化，从而导致总胆固醇和甘油三酯升高。
更深入地了解 RA 治疗对动脉粥样硬化过程的药理作用，可能会改善对关节和心脏损害的治疗。
