类风湿关节炎严重程度和心血管疾病高发的生物力学决定因素：两种复杂疾病的共同起源。
Biomechanical determinants of rheumatoid arthritis severity and excess cardiovascular disease: common origins of two complex diseases.
机构信息
Rheumatology, Hunter New England Local Health District, New Lambton, New South Wales, Australia
School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.
出版信息
RMD Open. 2024 Nov 21;10(4):e004524. doi: 10.1136/rmdopen-2024-004524.
OBJECTIVES
The determinants of rheumatoid arthritis (RA) severity and excess cardiovascular disease (CVD) are incompletely understood. Biomechanical factors are known to influence RA severity. Articular stiffness correlates with arterial and skin stiffness. This study explored the hypothesis that constitutional stiffness is a common determinant of RA severity and excess CVD.
METHODS
Fifty-eight patients with anti-CCP antibody (ACPA) positive RA and 57 controls were enrolled noting age, sex, body mass index, alcohol and tobacco exposure, Shared Epitope status and in RA disease duration, disease activity, ACPA titre and radiographic damage. Severe RA was defined as radiographic progression >1.3 mSharp points/year or requiring biological disease-modifying antirheumatic drugs (bDMARDs). Articular stiffness (Beighton Score and right 5th metacarpophalangeal (MCP) joint stress-strain responses), carotid-femoral pulse wave velocity and skin extensibility (percent increase distance two dots with manual traction dorsum right hand) were assessed.
RESULTS
Right 5th MCP stiffness correlated with Beighton Score and with arterial and skin stiffness. High radiographic rate was associated with greater MCP articular (t test p 0.014), arterial (p 0.044) and, in RA <5 years duration, greater skin stiffness (p 0.002) with similar trends in subjects requiring bDMARDs. In RA, arterial stiffness correlated with age (ß p<0.005), articular (ß p<0.001) and skin stiffness (ß p 0.037) and inversely with alcohol consumption (p 0.035).
CONCLUSIONS
Articular, arterial and skin stiffness correlated with each other and with RA severity. As skin is not affected by RA, this association suggests that constitutional stiffness might be a common determinant of RA and CVD. Prospective studies of at-risk preclinical and early RA are required to determine if this relationship is causal.
TRIALS REGISTRATION NUMBER
ACTRN12617000170325.
目的
类风湿关节炎（RA）严重程度和心血管疾病（CVD）风险增加的决定因素尚未完全阐明。生物力学因素会影响 RA 严重程度，关节僵硬与动脉僵硬和皮肤僵硬相关。本研究假设，固有僵硬是 RA 严重程度和 CVD 风险增加的共同决定因素。
方法
共纳入 58 例抗环瓜氨酸肽（ACPA）阳性 RA 患者和 57 例对照者，记录年龄、性别、体重指数、酒精和烟草暴露情况、共享表位状态、RA 病程、疾病活动度、ACPA 滴度和放射学损伤。严重 RA 定义为放射学进展>1.3 mSharp 点/年或需要生物 DMARDs 治疗。评估关节僵硬（Beighton 评分和右侧第 5 掌指关节（MCP）关节的应力-应变反应）、颈动脉-股动脉脉搏波速度和皮肤伸展性（右手背牵引两点之间的百分比增加距离）。
结果
右侧第 5 MCP 关节僵硬与 Beighton 评分以及动脉和皮肤僵硬相关。高放射学进展率与更大的 MCP 关节（t 检验，p=0.014）、动脉僵硬（p=0.044）以及在 RA 病程<5 年的患者中更大的皮肤僵硬（p=0.002）相关，在需要生物 DMARDs 治疗的患者中也有类似的趋势。在 RA 中，动脉僵硬与年龄（β p<0.005）、关节僵硬（β p<0.001）和皮肤僵硬（β p=0.037）相关，与酒精摄入（p=0.035）呈负相关。
结论
关节僵硬、动脉僵硬和皮肤僵硬相互关联，且与 RA 严重程度相关。由于皮肤不受 RA 影响，这种关联表明固有僵硬可能是 RA 和 CVD 的共同决定因素。需要对有风险的临床前和早期 RA 患者进行前瞻性研究，以确定这种关系是否具有因果关系。
临床试验注册号
ACTRN12617000170325。
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