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Thromboembolic and cardiovascular risk in rheumatoid arthritis: role of the haemostatic system
  1. I A M van den Oever1,
  2. N Sattar2,
  3. M T Nurmohamed1,3,4
  1. 1Department of Rheumatology, Jan van Breemen Research Institute/Reade, Amsterdam, The Netherlands
  2. 2BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
  3. 3Departments of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands
  4. 4Department of Rheumatology, VU University Medical Centre, Amsterdam, The Netherlands
  1. Correspondence to Dr Inge A M van den Oever, Department of Rheumatology, Jan van Breemen Research Centre/Reade, PO Box 58271, Amsterdam, The Netherlands; i.vd.oever{at}reade.nl

Abstract

Circumstantial evidence suggests that the innate immune system and coagulation system share a common evolutionary origin, which explains the extensive crosstalk between inflammatory cytokines and coagulation factors, with many components being important for both systems. This crosstalk has been extensively studied in sepsis, an acute state of high-grade inflammation. However, rheumatoid arthritis (RA) as well as many other autoimmune diseases can also be considered as a prothrombotic state. More and more studies show that autoimmune diseases, including RA, are a risk factor for cardiovascular disease, and also for venous thromboembolic events, such as pulmonary embolism and deep vein thrombosis. Inflammation and its effect on the haemostatic system is probably the link between these diseases. This viewpoint gives an update of the current literature on thromboembolic risk in RA, but also documents important knowledge gaps. This viewpoint will therefore help to focus on further research topics to improve diagnostic and therapeutic options which may relieve both the proinflammatory and the prothrombotic burden of autoimmune diseases.

  • Rheumatoid Arthritis
  • Autoimmune Diseases
  • Cardiovascular Disease
  • Inflammation

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