[Cardiovascular comorbidities in rheumatoid arthritis]

Approximately 80% of patients with rheumatoid arthritis (RA) suffer from comorbidities including more than 50% from cardiovascular (CV) diseases. Inflammatory activity is the main factor connecting RA with atherosclerosis, coronary heart disease, stroke, thromboembolic events and heart failure. Altogether these affect RA patients twice as frequently as the general population and CV events are the major cause of death in RA. Besides inflammatory activity, which can be reduced or eliminated by optimal treatment and controlling the RA activity, traditional CV risk factors also contribute to the total CV risk. These risk factors, such as hypertension, diabetes and hyperlipidemia can also be found more frequently in RA patients but often remain undetected and untreated for a long time. Reducing this deficit means improvement of the life expectancy for RA patients, which has been demonstrated in studies by treatment of hyperlipoproteinemia. Among the drugs used for RA treatment non-steroidal antirheumatic drugs and glucocorticoids increase the CV risk if used in the long term. Hydroxychloroquine, methotrexate and biologics on the other hand are able to dramatically reduce the risk. Elevated CV risks of inflammatory rheumatic diseases are widely unknown in primary care. Therefore, the rheumatologist should be responsible for assessment of risk factors but in real life motivation to do so is relatively low. Some studies could demonstrate that using nursing-based standardized assessment is an excellent opportunity to reduce these deficits. Depending on the individual risk reassessment should take place every 1-5 years.