Department of Rheumatology, Service De Rhumatologie, CHRU De Besançon, Besancon, France.
EA 4267 : "PEPITE", FHU Increase, Université Bourgogne - Franche Comte, UFR Santé, Besancon, France.
Expert Rev Clin Pharmacol. 2021 Sep;14(9):1105-1112. doi: 10.1080/17512433.2021.1932461. Epub 2021 Jun 1.
: Management of inflammatory rheumatic diseases has evolved based on improved treatment strategies and better management of comorbidities, specifically cardiovascular risk. Methotrexate is one of the first-line treatments in the management of inflammatory rheumatic diseases, but its cardiovascular effects are poorly understood. The purpose of this review is to assess the cardiovascular impact of methotrexate in inflammatory rheumatic disease.: Current knowledge about the mechanism of action of methotrexate on cardiovascular tissue is presented. A review of the literature in the Medline, Cochrane and Embase databases was performed. Current data about the cardiovascular effects of methotrexate in rheumatoid arthritis, psoriatic arthritis, and psoriasis are presented.: Mechanism of action of methotrexate is based on the antagonism of purines. It reduces systemic inflammation and oxidative stress and improves the major cardiovascular risk factors. Methotrexate improves cardiovascular risk in rheumatoid arthritis, psoriasis and psoriatic arthritis, but the mechanisms involved are partially identified. Data are controversial regarding its effects on endothelial function and atherosclerosis. Conversely, in the general population and in patients with HIV infection, methotrexate does not modify cardiovascular outcomes. Thus, methotrexate only improves cardiovascular risk by reducing systemic inflammation, and should not be used to prevent cardiovascular events.
炎症性风湿病的治疗方法已经发展，这是基于改进的治疗策略和更好地控制合并症，特别是心血管风险。甲氨蝶呤是治疗炎症性风湿病的一线药物之一，但它对心血管的影响知之甚少。本综述的目的是评估甲氨蝶呤在炎症性风湿病中的心血管影响。
目前提出了甲氨蝶呤对心血管组织作用机制的知识。在 Medline、Cochrane 和 Embase 数据库中进行了文献复习。目前介绍了甲氨蝶呤在类风湿关节炎、银屑病关节炎和银屑病中的心血管作用的数据。
甲氨蝶呤的作用机制基于嘌呤的拮抗作用。它可降低全身炎症和氧化应激，并改善主要心血管危险因素。甲氨蝶呤可改善类风湿关节炎、银屑病和银屑病关节炎的心血管风险，但涉及的机制部分确定。关于其对内皮功能和动脉粥样硬化的影响，数据存在争议。相反，在普通人群和 HIV 感染者中，甲氨蝶呤不会改变心血管结局。因此，甲氨蝶呤仅通过降低全身炎症来改善心血管风险，不应用于预防心血管事件。
