Godbole Saloni, Solomon Jenny Lue, Johnson Maryann, Srivastava Ankita, Carsons Steven E, Belilos Elise, De Leon Joshua, Reiss Allison B
Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA.
Biomedicines. 2024 Jul 19;12(7):1608. doi: 10.3390/biomedicines12071608.
Despite progress in treating rheumatoid arthritis, this autoimmune disorder confers an increased risk of developing cardiovascular disease (CVD). Widely used screening protocols and current clinical guidelines are inadequate for the early detection of CVD in persons with rheumatoid arthritis. Traditional CVD risk factors alone cannot be applied because they underestimate CVD risk in rheumatoid arthritis, missing the window of opportunity for prompt intervention to decrease morbidity and mortality. The lipid profile is insufficient to assess CVD risk. This review delves into the connection between systemic inflammation in rheumatoid arthritis and the premature onset of CVD. The shared inflammatory and immunologic pathways between the two diseases that result in subclinical atherosclerosis and disrupted cholesterol homeostasis are examined. The treatment armamentarium for rheumatoid arthritis is summarized, with a particular focus on each medication's cardiovascular effect, as well as the mechanism of action, risk-benefit profile, safety, and cost. A clinical approach to CVD screening and treatment for rheumatoid arthritis patients is proposed based on the available evidence. The mortality gap between rheumatoid arthritis and non-rheumatoid arthritis populations due to premature CVD represents an urgent research need in the fields of cardiology and rheumatology. Future research areas, including risk assessment tools and novel immunotherapeutic targets, are highlighted.
尽管在类风湿关节炎的治疗方面取得了进展，但这种自身免疫性疾病会增加患心血管疾病（CVD）的风险。广泛使用的筛查方案和当前的临床指南不足以早期发现类风湿关节炎患者的心血管疾病。仅靠传统的心血管疾病风险因素是不够的，因为它们会低估类风湿关节炎患者的心血管疾病风险，从而错过及时干预以降低发病率和死亡率的时机。血脂水平不足以评估心血管疾病风险。本综述深入探讨类风湿关节炎中的全身炎症与心血管疾病过早发病之间的联系。研究了两种疾病之间导致亚临床动脉粥样硬化和胆固醇稳态破坏的共同炎症和免疫途径。总结了类风湿关节炎的治疗手段，特别关注每种药物的心血管作用、作用机制、风险效益概况、安全性和成本。基于现有证据，提出了针对类风湿关节炎患者进行心血管疾病筛查和治疗的临床方法。由于心血管疾病过早发作，类风湿关节炎患者与非类风湿关节炎人群之间的死亡率差距是心脏病学和风湿病学领域迫切需要研究的问题。强调了未来的研究领域，包括风险评估工具和新型免疫治疗靶点。
