Prevention of Stroke in Rheumatoid Arthritis.
The risk of cerebrovascular disease is increased among rheumatoid arthritis (RA) patients and remains an underserved area of medical need. Only a minor proportion of RA patients achieve suitable stroke prevention. Classical cardiovascular risk factors appear to be under-diagnosed and undertreated among patients with RA. Reducing the inflammatory burden is also necessary to lower the cardiovascular risk. An adequate control of disease activity and cerebrovascular risk assessment using national guidelines should be recommended for all patients with RA. For patients with a documented history of cerebrovascular or cardiovascular risk factors, smoking cessation and corticosteroids and non-steroidal anti-inflammatory drugs at the lowest dose possible are crucial. Risk score models should be adapted for patients with RA by introducing a 1.5 multiplication factor, and their results interpreted to appropriately direct clinical care. Statins, angiotensin-converting enzyme inhibitors, and angiotensin-II receptor blockers are preferred treatment options. Biologic and non-biologic disease-modifying anti-rheumatic drugs should be initiated early to mitigate the necessity of symptom control drugs and to achieve early alleviation of the inflammatory state. Early control can improve vascular compliance, decrease atherosclerosis, improve overall lipid and metabolic profiles, and reduce the incidence of heart disease that may lead to atrial fibrillation. In patients with significant cervical spine involvement, early intervention and improved disease control are necessary and may prevent further mechanical vascular injury.
Department of Neurology, The Ohio State University College of Medicine, Columbus, OH, USA.
Alicia M
AM
Zha
Neurological Service, San Camillo de' Lellis General Hospital, Rieti, Italy.|SMDN-Neurological Section, Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy.
Mario
M
Di Napoli
Department of Neurology, School of Medicine, University of Texas Health Science Center San Antonio, Medical Arts and Research Center, 8300 Floyd Curl Drive, MC 7883, San Antonio, TX, 78229, USA. Behrouz@uthscsa.edu.
Réza
R
Behrouz
D000818:Animals; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications*; D006801:Humans; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000517:prevention & control*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
Autoimmune disease; Cerebrovascular disease; Inflammation; Rheumatoid arthritis; Risk factors; Stroke