Accelerated atherosclerosis in rheumatoid arthritis.
Cardiovascular disease is a leading cause of mortality in rheumatoid arthritis (RA). Endothelial dysfunction often precedes manifest atherosclerosis. Both traditional, Framingham risk factors and inflammation-associated factors are involved in RA-associated atherosclerosis. Among imaging techniques, the early determination of common carotid intima-media thickness (ccIMT), flow-mediated vasodilation (FMD), and nitroglycerine-mediated vasodilation (NMD) may be useful to determine atherosclerosis and endothelial dysfunction. We and others found increased ccIMT and impaired FMD in RA patients. Among immunological and metabolic laboratory markers, anticyclic citrullinated peptide (anti-CCP) antibodies, IgM rheumatoid factor, circulating immune complexes, pro-inflammatory cytokines including tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6), Th0/Th1 T cells, homocysteine, dyslipidemia, decreased folate and vitamin B12 production, and impaired paraoxonase activity may all be involved in the development of vascular disease in RA. The early diagnosis of endothelial dysfunction and atherosclerosis, active immunosuppressive treatment, the use of drugs that control atherosclerosis, changes in sedentary lifestyle, and the close follow-up of RA patients may help to minimize cardiovascular risk in these individuals.
Szekanecz
Zoltán
Z
Division of Rheumatology, Third Department of Medicine, University of Debrecen Medical and Health Science Center, Debrecen, Hungary. szekanecz@iiibel.dote.hu
Kerekes
György
G
Dér
Henriett
H
Sándor
Zsuzsa
Z
Szabó
Zoltán
Z
Végvári
Anikó
A
Simkovics
Enikö
E
Soós
Lilla
L
Szentpétery
Agnes
A
Besenyei
Timea
T
Szücs
Gabriella
G
Szántó
Sándor
S
Tamási
László
L
Szegedi
Gyula
G
Shoenfeld
Yehuda
Y
Soltész
Pál
P
D001172:Arthritis, Rheumatoid / Q000150:complications*; D050197:Atherosclerosis / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D004730:Endothelium, Vascular / Q000473:pathology*; D006801:Humans; D012307:Risk Factors