Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DePReMeI), Università degli Studi di Bari, Italy.
Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Roma La Sapienza, Rome, Italy.
Clin Exp Rheumatol. 2023 Sep;41(9):1784-1791. doi: 10.55563/clinexprheumatol/hyaki6. Epub 2023 Mar 2.
Rheumatoid arthritis (RA) patients are at high risk of cardiovascular (CV) events. The aim of this position paper is to provide Italian rheumatologists with an easy, feasible and time-saving CV risk assessment in their daily clinical practice.
A narrative review of the literature and an assessment of the methodological strength underlying the current evidence on CV risk assessment in patients with RA were performed. The evidence-based results were shared among the members of the steering committee of the CORDIS study group of the Italian Society of Rheumatology. Subsequently, a unanimously agreed-upon algorithm was discussed and finally approved by the experts.
RA patients should have their CV profile monitored using the Italian 'Progetto Cuore' chart, according to the current EULAR recommendations for CV risk management, at least every 5 years. In the presence of high disease activity, or a multi-drug failure condition, when prolonged treatment with glucocorticoids and/or NSAIDs is required, or if hypertension, dyslipidaemia, or diabetes mellitus are concomitant, a more stringent CV risk assessment should be considered. When moderate CV risk is documented, patients should undergo intima-media thickening measurement. The condition of high CV risk requires a cardiological evaluation.
This position paper provides five Italian recommendations for CV risk assessment in RA patients. A general and uniform approach to CV risk profiling may be useful to identify those patients who should undertake intensive preventive strategies to improve their CV outcomes.
类风湿关节炎（RA）患者存在发生心血管（CV）事件的高风险。本文旨在为意大利风湿病学家提供一种在日常临床实践中简便、可行且省时的 CV 风险评估方法。
对 RA 患者 CV 风险评估的文献进行叙述性综述，并评估当前证据的方法学强度。将循证结果在意大利风湿病学会 CORDIS 研究组指导委员会成员中进行分享。随后，对一致同意的算法进行讨论，并最终由专家批准。
根据目前 EULAR 推荐的 CV 风险管理建议，RA 患者应根据现行的意大利“Progetto Cuore”图表监测其 CV 情况，至少每 5 年监测一次。在疾病活动度高、多药治疗失败、需要长期使用糖皮质激素和/或 NSAIDs 治疗、或存在高血压、血脂异常或糖尿病等情况下，应考虑更严格的 CV 风险评估。当存在中度 CV 风险时，患者应进行内中膜厚度测量。当 CV 风险较高时，需要进行心脏评估。
本文提出了 5 条针对 RA 患者 CV 风险评估的意大利建议。对 CV 风险进行全面且统一的评估可能有助于识别需要采取强化预防策略以改善 CV 结局的患者。
