Cardiovascular risk rheumatoid arthritis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

The central role of inflammation in atherogenesis strongly suggests that decreasing systemic inflammation will play an important role in CVD prevention and therapy in RA.

Inflammation leads directly to vascular endothelial dysfunction by means of the effects of cytokines on endothelial cells and the production of reactive oxygen species (increased oxidant stress).

Furthermore, the presence of systemic inflammation increases the risk of developing CV risk factors such as hypertension, insulin resistance/diabetes mellitus, dyslipidemia, and visceral obesity.

The increased risk of the development of CV risk factors and events associated with higher levels of markers of systemic inflammation in the general population implied that RA patients are at even greater risk, because of the intensity and duration of the inflammatory processes in their disease.

Aggressive management of RA is therefore indicated, not only in an effort to maintain joint structure and function, but also to preserve cardiovascular health. Because inflammation (and disturbed endothelial function) is present even prior to diagnosis, RA patients require regular surveillance for cardiovascular risk factors from the time of initial diagnosis, regardless of age or sex.

Treatment of risk factors in RA is important but may be complicated by interactions with agents used to disease therapy (e.g., use of both ASA and NSAIDS, unknown long-term effects of using MTX with statins). Nevertheless, the increased morbidity and mortality from CVD in RA mandates a proactive approach to CVD prevention.

RA patients also must be educated regarding their increased risk of CVD and instructed in dietary and lifestyle habits that are beneficial to their CV health. A multifaceted approach to CVD prevention in RA patients is critical to decreasing their risk of CV morbidity and mortality. Aggressive therapy is warranted for patients who have rheumatoid arthritis.

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