title: Vascular function and morphology in rheumatoid arthritis: a systematic review.
abstract: OBJECTIVE
  RA associates with significantly increased morbidity and mortality from cardiovascular disease (CVD). This may be due to complex interactions between traditional CVD risk factors, systemic rheumatoid inflammation and the vasculature. We reviewed the current literature to answer: (i) whether there is sufficient evidence that patients with RA have altered vascular function and morphology compared with normal controls; (ii) whether there is sufficient evidence to determine if such changes relate predominantly to systemic inflammation; and (iii) whether any changes of vascular function and morphology in RA can be modified with therapy.
  
  
  METHODS
  The MEDLINE database was searched to identify publications from 1974 to 1 November 2010 pertaining to vascular function and morphology in RA. The total number of articles included in the present review was 93. This included 57 cross-sectional studies, 27 longitudinal studies without randomization and 9 longitudinal studies with randomization.
  
  
  RESULTS
  Vascular function and morphology was impaired in RA relative to healthy controls. The majority of studies reported no associations between systemic inflammation and vascular function. Treatment with anti-inflammatory medication resulted in both transient and long-term improvements in the vasculature, but only a few studies reported associations between change in inflammation and change in vascular function and morphology.
  
  
  CONCLUSIONS
  The link between systemic inflammation and vascular function and morphology is not wholly supported by the available literature. Long-term studies examining specific predictors (including CVD risk factors) on the vasculature in RA are needed.
authors.affiliation: Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Pensnett Road, Dudley, West Midlands DY1 2HQ, UK. aamer.sandoo@dgh.nhs.uk
authors.forename: Aamer
authors.initials: A
authors.lastname: Sandoo
authors.forename: Jet J C S
authors.initials: JJ
authors.lastname: Veldhuijzen van Zanten
authors.forename: George S
authors.initials: GS
authors.lastname: Metsios
authors.forename: Douglas
authors.initials: D
authors.lastname: Carroll
authors.forename: George D
authors.initials: GD
authors.lastname: Kitas
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology; D001808:Blood Vessels / Q000187:drug effects / Q000473:pathology* / Q000503:physiopathology; D015897:Comorbidity; D005260:Female; D006801:Humans; D007596:Joints / Q000098:blood supply*; D008297:Male; D014652:Vascular Diseases / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology
chemical_list: D000893:Anti-Inflammatory Agents