Atherosclerosis in rheumatoid arthritis and systemic lupus erythematosus

Area of Science:

• Cardiovascular Medicine
• Rheumatology
• Immunology

Background:

• Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are chronic inflammatory diseases.
• These conditions are associated with an increased risk of atherosclerosis and coronary heart disease (CHD).
• The mechanisms linking inflammation to accelerated atherogenesis in RA and SLE require further elucidation.

Purpose of the Study:

• To review recent studies on the elevated risk of atherosclerosis and CHD in RA and SLE patients.
• To examine the strength of this association and the role of inflammation.
• To evaluate the potential impact of therapies on cardiovascular risk in these populations.

Main Methods:

• Systematic review of recent scientific literature.
• Analysis of studies investigating the association between RA/SLE and cardiovascular disease.
• Evaluation of inflammatory pathways and metabolic alterations contributing to atherogenesis.
• Assessment of current and emerging therapeutic strategies for cardiovascular risk reduction.

Main Results:

• Atherosclerosis is more prevalent and accelerated in patients with RA and SLE, potentially preceding clinical disease onset.
• Metabolic changes, including insulin resistance and altered HDL, and inflammatory mechanisms (macrophage activation, interferon-1, complement deficiency) contribute to atherogenesis.
• Hydroxychloroquine may reduce CHD risk, while anti-tumour necrosis factor drugs show potential but require further biomarker validation.
• Consensus on primary preventive strategies remains elusive.

Conclusions:

• Urgent need for clinical trials to test lipid-lowering and inflammatory hypotheses of atherosclerosis in RA and SLE.
• Novel targeted therapies under development hold promise for mitigating future CHD risk in these patient groups.