风湿性关节炎的心血管负担 - 对治疗的影响
1The Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
The American journal of medicine
|September 24, 2023
概括
类风湿性关节炎 (RA) 患者面临两倍的死亡风险,主要是由慢性炎症驱动的心血管疾病. 早期疾病控制和管理传统风险因素对于改善RA心血管结果至关重要.
科学领域:
- 心血管医学 心血管医学
- 类风湿病学 类风湿病学
- 免疫学 免疫学 免疫学
背景情况:
- 类风湿性关节炎 (RA) 与死亡率增加两倍相比对照.
- 心血管疾病 (CVD) 是 RA 患者过度死亡的主要原因.
- 病变发生涉及主要动脉的加速,过早和渐进性动脉样硬化,通常是隐藏和治疗不足的.
研究的目的:
- 突出RA患者显著的心血管风险.
- 强调RA中心血管疾病的多因素驱动因素,包括全身炎症和传统风险因素.
- 提出改善RA心血管结果的策略.
主要方法:
- 对RA中心血管疾病的发病和风险因素的审查.
- 分析心血管风险的决定因素,包括炎症标志物,疾病严重程度和持续时间.
- 评估治疗策略,以保护心血管在RA.
主要成果:
- 慢性系统性自身免疫性炎症是RA中加速动脉样硬化的关键驱动因素.
- 传统的风险因素和治疗副作用也对心血管疾病风险作出了重大贡献.
- 目前的方法往往低估了RA患者的心血管风险.
- 炎症标志物,疾病严重程度和持续时间是主要的风险决定因素.
结论:
- 在RA中,心血管保护需要早期和积极地抑制炎症以实现缓解或降低疾病活性 ("治疗到目标").
- 对传统风险因素的全面管理至关重要,但往往被忽视.
- 合理使用葡萄糖皮质类药物,限制长期暴露和剂量,对于减轻相关危害很重要.
- 需要采用多方面的方法来改善RA患者未来的心血管结果.
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