Service de Rhumatologie, Hôpital Cochin, Centre - Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75014 Paris, France.
Service de Rhumatologie, Hôpital Cochin, Centre - Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75014 Paris, France.
Joint Bone Spine. 2023 Sep;90(5):105592. doi: 10.1016/j.jbspin.2023.105592. Epub 2023 May 16.
Patients with rheumatoid arthritis (RA) and other chronic inflammatory rheumatic disorders have increased risk of cardiovascular disease (CVD) and venous thromboembolism (VTE) compared with the general population. Moreover, recent data have raised concerns around a possible increased risk of major CV events (MACE) and VTE in patients treated with JAK inhibitors (JAKi). In October 2022, the PRAC has recommended measures to minimize the risk of serious side effects, including CV conditions and VTE, associated with all approved in chronic inflammatory diseases.
To provide an adequate and feasible strategy to evaluate, at the individual level, the risk of CVD and VTE in patients with chronic inflammatory rheumatic diseases.
A multidisciplinary steering committee comprised 11 members including rheumatologists, a cardiologist, a hematologist expert in thrombophilia and fellows. Systematic literature searches were performed and evidence was categorized according to standard guidelines. The evidence was discussed and summarized by the experts in the course of a consensus finding and voting process.
Three overarching principles were defined. First, there is a higher risk of MACE and VTE in patients with chronic inflammatory rheumatic diseases compared with the general population. Second, the rheumatologist has a central role in the evaluation of the risk of CVD and VTE in patient with chronic inflammatory rheumatic diseases. Third, the risk of MACE and VTE should be regularly assessed in patients with chronic inflammatory rheumatic diseases, particularly before initiating targeted therapies. Eleven recommendations were defined to prevent potentially life-threatening complications of CVD and VTE in patients with chronic inflammatory rheumatic diseases, providing practical assessment of CVD and VTE before considering the prescription of targeted therapies, and especially JAKi.
These practical recommendations based on expert opinion and scientific evidence provide consensus for the prevention and the assessment of CVD and VTE.
与普通人群相比，类风湿关节炎（RA）和其他慢性炎症性风湿病患者的心血管疾病（CVD）和静脉血栓栓塞（VTE）风险增加。此外，最近的数据引发了人们对接受 JAK 抑制剂（JAKi）治疗的患者发生重大心血管事件（MACE）和 VTE 风险增加的担忧。2022 年 10 月，PRAC 建议采取措施，尽量减少与所有批准用于慢性炎症性疾病的药物相关的严重副作用风险，包括心血管疾病和 VTE。
提供一种充分且可行的策略，以评估慢性炎症性风湿病患者发生 CVD 和 VTE 的个体风险。
一个由 11 名成员组成的多学科指导委员会，包括风湿病学家、心脏病专家、血栓形成专家和研究员。进行了系统的文献检索，并根据标准指南对证据进行了分类。专家们在共识发现和投票过程中讨论和总结了证据。
确定了三项总体原则。首先，与普通人群相比，慢性炎症性风湿病患者发生 MACE 和 VTE 的风险更高。其次，风湿病学家在评估慢性炎症性风湿病患者 CVD 和 VTE 风险方面发挥核心作用。第三，应定期评估慢性炎症性风湿病患者的 MACE 和 VTE 风险，特别是在开始靶向治疗之前。确定了 11 项建议，以预防慢性炎症性风湿病患者 CVD 和 VTE 的潜在危及生命的并发症，在考虑开具靶向治疗药物，特别是 JAKi 之前，为 CVD 和 VTE 的评估提供实用方法。
这些基于专家意见和科学证据的实用建议为 CVD 和 VTE 的预防和评估提供了共识。
