IRC-FSH Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
Nutramed S.c.a.r.l, Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy.
Biomolecules. 2021 Jan 10;11(1):81. doi: 10.3390/biom11010081.
Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory autoimmune disease that affects about 1% of the global population, with a female-male ratio of 3:1. RA preferably affects the joints, with consequent joint swelling and deformities followed by ankylosis. However, evidence has accumulated showing that patients suffering from RA can also develop extra-articular manifestations, including cardiovascular disease states, neuropathies, and multiorgan dysfunction. In particular, peripheral nerve disorders showed a consistent impact in the course of the disease (prevalence about 20%) mostly associated to vasculitis of the nerve vessels leading to vascular ischemia, axonal degeneration, and neuronal demyelination. The pathophysiological basis of this RA-associated microvascular disease, which leads to impairment of assonal functionality, is still to be better clarified. However, endothelial dysfunction and alterations of the so-called brain-nerve barrier (BNB) seem to play a fundamental role. This review aims to assess the potential mechanisms underlying the impairment of endothelial cell functionality in the development of RA and to identify the role of dysfunctional endothelium as a causative mechanism of extra-articular manifestation of RA. On the other hand, the potential impact of lifestyle and nutritional interventions targeting the maintenance of endothelial cell integrity in patients with RA will be discussed as a potential option when approaching therapeutic solutions in the course of the disease.
类风湿关节炎（RA）是一种慢性、系统性、炎症性自身免疫性疾病，影响全球约 1%的人口，女性与男性的比例为 3:1。RA 主要影响关节，导致关节肿胀和畸形，随后出现关节强直。然而，有证据表明，患有 RA 的患者还可能出现关节外表现，包括心血管疾病状态、神经病变和多器官功能障碍。特别是周围神经疾病在疾病过程中表现出一致的影响（患病率约为 20%），主要与神经血管的血管炎有关，导致血管缺血、轴突变性和神经元脱髓鞘。导致轴突功能障碍的这种 RA 相关微血管疾病的病理生理基础仍需进一步阐明。然而，内皮功能障碍和所谓的脑-神经屏障（BNB）的改变似乎起着至关重要的作用。本综述旨在评估内皮细胞功能障碍在 RA 发展过程中导致的损害的潜在机制，并确定功能失调的内皮细胞作为 RA 关节外表现的致病机制的作用。另一方面，将讨论针对维持 RA 患者内皮细胞完整性的生活方式和营养干预的潜在影响，作为疾病过程中治疗方法的潜在选择。
