Atherosclerosis in Rheumatoid Arthritis: Promoters and Opponents

Area of Science:

• Rheumatology
• Cardiology
• Immunology

Background:

• Cardiovascular diseases (CVD) are a leading cause of mortality in rheumatoid arthritis (RA) patients.
• Current CVD risk stratification algorithms underestimate risk in RA patients.
• Accelerated atherosclerosis, sharing pathways with RA synovitis, drives acute CV events in RA.

Purpose of the Study:

• To review the pathophysiology of atherogenesis in RA patients.
• To explore potential anti-atherosclerotic effects of disease-modifying anti-rheumatic drugs (DMARDs).

Main Methods:

• Narrative review of epidemiological data and pathophysiological studies.
• Analysis of shared pathways between atherosclerosis and RA synovitis.
• Consideration of genetic, metabolic, microbiome, and inflammatory factors.

Main Results:

• RA is associated with accelerated atherosclerosis due to shared inflammatory pathways.
• Factors like genetics, metabolism, gut microbiome, and systemic inflammation contribute to atherosclerosis in RA.
• DMARDs may offer potential anti-atherosclerotic benefits.

Conclusions:

• Understanding shared pathophysiological pathways is crucial for effective CV prevention in RA.
• Tailored CV risk screening and intensive prevention strategies are needed for RA patients.
• Further research into DMARDs' anti-atherosclerotic effects is warranted.