The Cardiovascular Burden of Rheumatoid Arthritis - Implications for Treatment

Area of Science:

• Cardiovascular Medicine
• Rheumatology
• Immunology

Background:

• Rheumatoid arthritis (RA) is associated with a two-fold increase in mortality compared to controls.
• Cardiovascular diseases (CVD) are a primary cause of excess mortality in RA patients.
• Pathogenesis involves accelerated, premature, and progressive atherosclerosis in major arteries, often occult and undertreated.

Purpose of the Study:

• To highlight the significant cardiovascular risk in RA patients.
• To emphasize the multifactorial drivers of CVD in RA, including systemic inflammation and traditional risk factors.
• To propose strategies for improving cardiovascular outcomes in RA.

Main Methods:

• Review of pathogenesis and risk factors for CVD in RA.
• Analysis of determinants of cardiovascular risk, including inflammatory markers, disease severity, and duration.
• Evaluation of treatment strategies for cardiovascular protection in RA.

Main Results:

• Chronic systemic autoimmune inflammation is a key driver of accelerated atherosclerosis in RA.
• Traditional risk factors and treatment side effects also contribute significantly to CVD risk.
• Current methods often underestimate the cardiovascular risk in RA patients.
• Inflammatory markers, disease severity, and duration are major risk determinants.

Conclusions:

• Cardiovascular protection in RA requires early and aggressive suppression of inflammation to achieve remission or low disease activity ('treat-to-target').
• Comprehensive management of traditional risk factors is essential and often neglected.
• Judicious use of glucocorticoids, limiting long-term exposure and dosage, is important to mitigate associated harms.
• A multipronged approach is necessary to improve future cardiovascular outcomes in RA patients.