Inflammation and atherosclerosis in rheumatoid arthritis.
Rheumatoid arthritis (RA) associates with increased cardiovascular mortality. This appears to be predominantly due to ischaemic causes, such as myocardial infarction and congestive heart failure. The higher prevalence of cardiac ischaemia in RA is thought to be due to the accelerated development of atherosclerosis. There are two main reasons for this, which might be inter-related: the systemic inflammatory load, characteristic of RA; and the accumulation in RA of classical risk factors for coronary heart disease, which is reminiscent of the metabolic syndrome. We describe and discuss in the context of RA the involvement of local and systemic inflammatory processes in the development and rupture of atherosclerotic plaques, as well as the role of individual risk factors for coronary heart disease. We also present the challenges facing the clinical and scientific communities addressing this problem, which is receiving increasing attention.
Stevens
Robert J
RJ
Cardiovascular Comorbidity Research Group, Department of Rheumatology, The Guest Hospital, Dudley Group of Hospitals NHS Trust, Tipton Road, Dudley, DY1 4SE, UK. rjstevens29@hotmail.com
Douglas
Karen M J
KM
Saratzis
Athanasios N
AN
Kitas
George D
GD
D000818:Animals; D001172:Arthritis, Rheumatoid / Q000150:complications*; D050197:Atherosclerosis / Q000209:etiology*; D016207:Cytokines / Q000378:metabolism; D004195:Disease Models, Animal; D018450:Disease Progression; D006360:Heat-Shock Proteins / Q000378:metabolism; D006801:Humans; D007239:Infections / Q000150:complications; D007249:Inflammation / Q000209:etiology / Q000503:physiopathology; D008077:Lipoproteins, LDL / Q000378:metabolism; D051379:Mice; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012307:Risk Factors; D012422:Rupture, Spontaneous
D016207:Cytokines; D006360:Heat-Shock Proteins; D008077:Lipoproteins, LDL; C099252:oxidized low density lipoprotein