Hansildaar Romy, Vedder Daisy, Baniaamam Milad, Tausche Anne-Kathrin, Gerritsen Martijn, Nurmohamed Michael T
Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and Reade, Amsterdam, Netherlands.
Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands.
Lancet Rheumatol. 2021 Jan;3(1):e58-e70. doi: 10.1016/S2665-9913(20)30221-6. Epub 2020 Sep 1.
The increased risk of cardiovascular morbidity and mortality in rheumatoid arthritis and gout has been increasingly acknowledged in past decades, with accumulating evidence that gout, just as with rheumatoid arthritis, is an independent cardiovascular risk factor. Although both diseases have a completely different pathogenesis, the underlying pathophysiological mechanisms in systemic inflammation overlap to some extent. Following the recognition that systemic inflammation has an important causative role in cardiovascular disease, anti-inflammatory therapy in both conditions and urate-lowering therapies in gout are expected to lower the cardiovascular burden of patients. Unfortunately, much of the existing data showing that urate-lowering therapy has consistent beneficial effects on cardiovascular outcomes in patients with gout are of low quality and contradictory. We will discuss the latest evidence in this respect. Cardiovascular disease risk management for patients with rheumatoid arthritis and gout is essential. Clinical guidelines and implementation of cardiovascular risk management in daily clinical practice, as well as unmet needs and areas for further investigation, will be discussed.
在过去几十年里，类风湿关节炎和痛风患者心血管疾病发病率和死亡率增加的情况已得到越来越多的认识，有越来越多的证据表明，痛风与类风湿关节炎一样，是一个独立的心血管危险因素。尽管这两种疾病的发病机制完全不同，但全身炎症的潜在病理生理机制在一定程度上存在重叠。在认识到全身炎症在心血管疾病中具有重要的致病作用之后，这两种疾病的抗炎治疗以及痛风的降尿酸治疗有望减轻患者的心血管负担。不幸的是，现有许多数据表明，降尿酸治疗对痛风患者的心血管结局具有一致的有益作用，但这些数据质量较低且相互矛盾。我们将讨论这方面的最新证据。对类风湿关节炎和痛风患者进行心血管疾病风险管理至关重要。将讨论临床指南以及心血管风险管理在日常临床实践中的实施情况，以及未满足的需求和进一步研究的领域。
