PDF(Pubmed)
Abstract：
Despite progress in treating rheumatoid arthritis, this autoimmune disorder confers an increased risk of developing cardiovascular disease (CVD). Widely used screening protocols and current clinical guidelines are inadequate for the early detection of CVD in persons with rheumatoid arthritis. Traditional CVD risk factors alone cannot be applied because they underestimate CVD risk in rheumatoid arthritis, missing the window of opportunity for prompt intervention to decrease morbidity and mortality. The lipid profile is insufficient to assess CVD risk. This review delves into the connection between systemic inflammation in rheumatoid arthritis and the premature onset of CVD. The shared inflammatory and immunologic pathways between the two diseases that result in subclinical atherosclerosis and disrupted cholesterol homeostasis are examined. The treatment armamentarium for rheumatoid arthritis is summarized, with a particular focus on each medication\'s cardiovascular effect, as well as the mechanism of action, risk-benefit profile, safety, and cost. A clinical approach to CVD screening and treatment for rheumatoid arthritis patients is proposed based on the available evidence. The mortality gap between rheumatoid arthritis and non-rheumatoid arthritis populations due to premature CVD represents an urgent research need in the fields of cardiology and rheumatology. Future research areas, including risk assessment tools and novel immunotherapeutic targets, are highlighted.
摘要：
尽管在治疗类风湿性关节炎方面取得了进展，这种自身免疫性疾病增加了患心血管疾病(CVD)的风险.广泛使用的筛查方案和当前的临床指南不足以在类风湿性关节炎患者中早期检测CVD。传统的CVD危险因素不能单独应用，因为它们低估了类风湿性关节炎的CVD风险，错过了及时干预以降低发病率和死亡率的机会之窗。血脂谱不足以评估CVD风险。这篇综述探讨了类风湿性关节炎的全身性炎症与CVD的过早发作之间的联系。检查了导致亚临床动脉粥样硬化和胆固醇稳态破坏的两种疾病之间的共有炎症和免疫途径。总结了类风湿关节炎的治疗方法，特别关注每种药物对心血管的影响，以及作用机制，风险-收益概况，安全,和成本。根据现有证据，提出了一种针对类风湿性关节炎患者进行CVD筛查和治疗的临床方法。由于过早CVD引起的类风湿性关节炎与非类风湿性关节炎人群之间的死亡率差距代表了心脏病学和风湿病学领域的迫切研究需求。未来的研究领域，包括风险评估工具和新的免疫治疗靶点，被突出显示。
