title: Comparative assessment of vascular function in autoimmune rheumatic diseases: considerations of prevention and treatment.
abstract: Numerous autoimmune-inflammatory rheumatic diseases have been associated with accelerated atherosclerosis or other types of vasculopathy leading to increased cardio- and cerebrovascular disease risk. Traditional risk factors, as well as the role of systemic inflammation including cytokines, chemokines, proteases, autoantibodies, adhesion receptors and others have been implicated in the development of these vascular pathologies. The characteristics of vasculopathies may significantly differ depending on the underlying disease. While classical accelerated atherosclerosis has been associated with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) or spondyloarthropathies (SpA), obliterative vasculopathy may rather be characteristic for systemic sclerosis (SSc) or mixed connective tissue disease (MCTD). Antiphospholipid antibodies have been implicated in vasculopathies underlying SLE, antiphospholipid syndrome (APS), RA and MCTD. There is also heterogeneity with respect to inflammatory risk factors. Cytokines, such as tumor necrosis factor-α (TNF-α) or interleukin 6 (IL-6) and immune complexes are primarily involved in arthritides, such as RA, SpA, as well as in SLE. On the other hand, autoantibodies including anti-oxLDL anti-cardiolipin and anti-β2GPI are rather involved in SLE- and APS-associated vasculopathies. Regarding the non-invasive assessment of vascular function, endothelial dysfunction, overt atherosclerosis and vascular stiffness may be indicated by brachial artery flow-mediated vasodilation (FMD), common carotid intima-media thickness (ccIMT) and aortic pulse-wave velocity (PWV), respectively. These abnormalities have been described in most inflammatory rheumatic diseases. While ccIMT and stiffness are relatively stable, FMD may be influenced by many confounding factors. In addition to traditional vasculoprotection, immunosuppressive agents including corticosteroids, traditional and biologic DMARDs may have significant vascular and metabolic effects. The official EULAR recommendations on the assessment and management of cardiovascular disease in arthritides have just been published, and similar recommendations in connective tissue diseases are to be developed soon.
authors.affiliation: University of Debrecen Medical and Health Sciences Center, Institute of Medicine, Third Department of Medicine, Angiology and Intensive Care Unit, Debrecen, Hungary.
authors.forename: Pál
authors.initials: P
authors.lastname: Soltész
authors.forename: György
authors.initials: G
authors.lastname: Kerekes
authors.forename: Henriett
authors.initials: H
authors.lastname: Dér
authors.forename: Gabriella
authors.initials: G
authors.lastname: Szücs
authors.forename: Sándor
authors.initials: S
authors.lastname: Szántó
authors.forename: Emese
authors.initials: E
authors.lastname: Kiss
authors.forename: Edit
authors.initials: E
authors.lastname: Bodolay
authors.forename: Margit
authors.initials: M
authors.lastname: Zeher
authors.forename: Orsolya
authors.initials: O
authors.lastname: Timár
authors.forename: Péter
authors.initials: P
authors.lastname: Szodoray
authors.forename: Gyula
authors.initials: G
authors.lastname: Szegedi
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Szekanecz
mesh_terms: D001327:Autoimmune Diseases / Q000150:complications* / Q000503:physiopathology* / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D008947:Mixed Connective Tissue Disease / Q000150:complications / Q000503:physiopathology; D012216:Rheumatic Diseases / Q000150:complications* / Q000503:physiopathology* / Q000517:prevention & control / Q000628:therapy; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications / Q000503:physiopathology; D025242:Spondylarthropathies / Q000150:complications / Q000503:physiopathology; D014652:Vascular Diseases / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy