7Cardiovascular co-morbidity in early rheumatoid arthritis
Section snippets
Cardiovascular disease co-morbidity in established RA
Rheumatoid arthritis is associated with heart disease. Pericardial disease, including pericarditis and pericardial effusions, have long been identified as extra-articular manifestations of RA and were first described by Charcot in 1881 [5]. The true prevalence of pericardial disease in association with RA is difficult to determine as it often remains clinically silent. Echocardiographic studies in established cohorts of RA patients have reported prevalence rates of pericardial disease between 1
What is early RA?
The definition of early RA is not always easy as the 1987 ACR classification criteria were derived from study of patients with established disease [48] and have not been found to be discriminatory at symptom onset [49]. For patients presenting with recent-onset inflammatory polyarthritis (IP) or undifferentiated inflammatory arthritis, it has been suggested that the patient should not be immediately classified but observed [50]. Experience in early arthritis clinics, such as the Leiden early
What is the evidence for CVD events or CVD risk factors prior to RA?
Retrospectively exploring medical records back to aged 18 years of all 603 patients in the Rochester RA incidence cohort revealed that in the 2-year period prior to fulfilling the diagnostic ACR criteria for RA, these participants were significantly more likely to have been hospitalized for an acute MI or to have experienced an unrecognized MI compared to non-RA subjects [14]. The previously discussed study examining co-morbidities in patients with early RA also revealed that for many patients
Conclusion
In summary, there is well-established evidence for CVD mortality and morbidity in patients with RA. However, the more recent evidence that CVD morbidity and mortality occurs early in the disease process, and the suggestion that pathogenic processes for atherosclerosis may be in place even before a diagnosis of RA, represents a new development in our understanding of CVD co-morbidity. Further research is required to explore CVD in early RA, particularly to elucidate the relative contributions of
Conflict of interest
The authors declare no conflict of interest.
Acknowledgements
H.J. is in receipt of an Arthritis Research Campaign (ARC) Educational Research Fellowship (number: 17883), and the Dudley Group of Hospitals NHS Trust Department of Rheumatology is in receipt of an infrastructure support grant from the ARC (number: 17682).
References (88)
- et al.
Comorbidities in rheumatoid arthritis
Best Pract Res Clin Rheumatol
(2007) - et al.
Mortality in established rheumatoid arthritis
Best Pract Res Clin Rheumatol
(2007) - et al.
Impaired glucose handling in active rheumatoid arthritis: relationship to the secretion of insulin and counter-regulatory hormones
Metabolism
(1987) - et al.
Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study
Lancet
(2002) - et al.
Does early rheumatoid arthritis exist?
Best Pract Res Clin Rheumatol
(2005) - et al.
Treating very early rheumatoid arthritis
Best Pract Res Clin Rheumatol
(2006) - et al.
Early treatment reduces the cardiovascular risk factors in newly diagnosed rheumatoid arthritis patients
Semin Arthritis Rheum
(2008) - et al.
New evidence for vascular disease in patients with early rheumatoid arthritis
Lancet
(2003) - et al.
Cardiovascular disease in rheumatoid arthritis
Biomed Pharmacother
(2006) - et al.
Smoking and smoking cessation - the relationship between cardiovascular disease and lipoprotein metabolism: a review
Atherosclerosis
(2008)
Dietary beta-cryptoxanthin and inflammatory polyarthritis: results from a population-based prospective study
Am J Clin Nutr
Epidemiology of rheumatoid arthritis: determinants of onset, persistence and outcome
Best Pract Res Clin Rheumatol
HLA-DRB1 status affects endothelial function in treated patients with rheumatoid arthritis
Am J Med
Longterm mortality outcome in patients with rheumatoid arthritis: early presenters continue to do well
J Rheumatol
Accelerated atherosclerosis. An extraarticular feature of rheumatoid arthritis
Arthritis Rheum
Occurrence of extraarticular disease manifestations is associated with excess mortality in a community based cohort of patients with rheumatoid arthritis
J Rheumatol
Coronary artery disease and rheumatoid arthritis
Curr Opin Rheumatol
Inflammation and atherosclerosis in rheumatoid arthritis
Expert Rev Mol Med
Cardiovascular admissions and mortality in an inception cohort of patients with rheumatoid arthritis with onset in the 1980s and 1990s
Ann Rheum Dis
Mortality of rheumatoid arthritis in Japan: a longitudinal cohort study
Ann Rheum Dis
Tackling ischaemic heart disease in rheumatoid arthritis
Rheumatology
Decreasing mortality in patients with rheumatoid arthritis: results from a large population based cohort in Sweden, 1964-95
J Rheumatol
Increase in cardiovascular and cerebrovascular disease prevalence in rheumatoid arthritis
J Rheumatol
Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis
Arthritis Rheum
Patterns of cardiovascular risk in rheumatoid arthritis
Ann Rheum Dis
Rheumatoid arthritis is an independent risk factor for ischaemic heart disease
Arthritis Rheum
Cardiovascular risk factors, including thrombotic variables, in a population with rheumatoid arthritis
Rheumatology
Echocardiographic findings, 24 hour electrocardiographic holter monitoring in patients with rheumatoid arthritis according to Steinbocker's criteria, functional index, value of Waaler-Rose titre and duration of disease
Clin Rheumatol
Excess recurrent cardiac events in rheumatoid arthritis patients with acute coronary syndrome
Ann Rheum Dis
Increased case fatality rates following a first acute cardiovascular event in patients with rheumatoid arthritis
Arthritis Rheum
Increased incidence of and impaired prognosis after acute myocardial infarction among patients with seropositive rheumatoid arthritis
Ann Rheum Dis
Disease modification and cardiovascular risk reduction: two sides of the same coin?
Rheumatology
Risk assessment for coronary heart disease in rheumatoid arthritis and osteoarthritis
Scand J Rheumatol
Hypertension in rheumatoid arthritis
Rheumatology
Atherogenic lipid profiles and its management in patients with rheumatoid arthritis
Vasc Health Risk Manag
Lipid profiles in untreated patients with rheumatoid arthritis
J Rheumatol
Influence of glucocorticoids and disease activity on total and high density lipoprotein cholesterol in patients with rheumatoid arthritis
Ann Rheum Dis
Modulation of lipoprotein plasma concentrations during long-term anti-TNF therapy in patients with active rheumatoid arthritis
Ann Rheum Dis
Blockade of tumour necrosis factor alpha in rheumatoid arthritis: effects on components of rheumatoid cachexia
Rheumatology
Redefining overweight and obesity in rheumatoid arthritis patients
Ann Rheum Dis
Rheumatoid arthritis and diabetes mellitus: evidence for an association?
J Rheumatol
Potential role of statins and PPARs in rheumatoid arthritis
Future Rheumatol
Rheumatoid factor, smoking and disease severity: associations with mortality in rheumatoid arthritis
J Rheumatol
Cited by (67)
Virtual training of rheumatoid arthritis peer coaches in motivational interviewing skills and concepts of cardiovascular disease
2023, Contemporary Clinical Trials CommunicationsRegulation of IL-17 in atherosclerosis and related autoimmunity
2015, CytokineCitation Excerpt :As mentioned above, a higher incidence of atherosclerosis is observed in patients with pre-existing systemic autoimmune disorders. These atherosclerosis-related autoimmune diseases include psoriasis [36–40], rheumatoid arthritis [41–44], systemic lupus erythematosus (SLE) [45–47], and diabetes mellitus [48–50], all of which are mediated by aberrantly activated self-reactive T cells (Table 1). Increasing prevalence of atherosclerosis and cardiovascular diseases in patients with related autoimmunity may account for the cause of death in autoimmune patients.
Uncontrolled blood pressure among hypertensive adults with rheumatoid arthritis in Saudi Arabia: A cross-sectional study
2022, Medicine (United States)Immunologic aspects of dyslipidemia: A critical regulator of adaptive immunity and immune disorders
2021, Journal of Lipid and Atherosclerosis