Cardiovascular risk rheumatoid arthritis
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known 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 pivitol role of inflammation in the development of atherosclerosis suggests that decreasing systemic inflammation will play an important role in cardiovascular disease prevention and therapy in RA.
Inflammation leads directly to abnormalities in the cells that line arterial walls. This is called "vascular endothelial dysfunction". What causes this are cytokines, protein messengers that promote inflammation in endothelial cells and lead to the production of reactive oxygen species which cause further damage.
In addition, systemic inflammation increases the risk of developing cardiovascular risk factors such as hypertension, insulin resistance, diabetes mellitus, hyperlipidemia, and obesity.
The association of increased cardiovascular risk factors and higher levels of markers of systemic inflammation implies that rheumatoid arthritis (RA) patients are at even greater risk, because of the intensity and duration of inflammation with their disease.
Aggressive management of RA is therefore indicated, not only to maintain normal joint structure and function, but also to ensure cardiovascular health. Because inflammation (and damage to endothelial cell function) is present even prior to diagnosis, RA patients require routine and constant surveillance for cardiovascular risk factors from the time of initial diagnosis, regardless of age or gender.
Treatment of risk factors in RA is important but may be complicated by interactions with agents used to treat the disease (e.g., use of both aspirin and non-steroidal anti-inflammatory drugs as well as the unknown long-term effects of using methotrexate and statins). Nevertheless, the increased morbidity and mortality from cardiovascular disease in RA dictates an aggressive approach to cardiovascular protection.
RA patients also must be educated regarding their increased risk of cardiovascular disease and instructed in dietary and lifestyle habits that are beneficial to their cardiovascular health. A multi-pronged approach to cardiovascular disease prevention in RA patients is critical to decreasing their risk of morbidity and mortality.
While the data is still not clear cut, it appears that a comprehensive aggressive approach using biologic therapy may reduce cardiovascular risk.
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