风湿性关节炎患者的心血管风险评估
Ruxandra Oiegar1,2, Dana Pop1,3
14th Department of Internal Medicine, Department of Cardiology Rehabilitation, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
Journal of clinical medicine
|September 27, 2025
概括
类风湿性关节炎 (RA) 患者由于慢性炎症而面临更高的心血管风险,即使看似有利的脂质样本. 标准的风险评估往往低估了这种危险,需要专门的评估方法,如动脉超声波.
科学领域:
- 类风湿病学 类风湿病学
- 心脏病学 心脏病学
- 免疫学 免疫学 免疫学
背景情况:
- 类风湿性关节炎 (RA) 是一种慢性炎症状况,会影响结膜.
- RA 驱动的炎症加速动脉样硬化,这是心血管疾病 (CVD) 的主要原因之一.
研究的目的:
- 在RA患者中合成传统和RA特异性心血管风险因素 (CVR).
- 审查目前对RA患者的CVR评估指南.
主要方法:
- 进行了全面的PubMed文献搜索.
- 综合了关于CVR因素和RA评估的关键发现.
主要成果:
- RA 患者表现出"脂质悖论",总和 LDL 胆固醇低,但高 HDL 胆固醇高,但面临心血管疾病风险升高.
- 慢性炎症会增加胆固醇代谢,并损害高密度胆固醇功能,导致心血管事件发生率更高.
- 血清C反应蛋白 (CRP) 水平与心血管风险密切相关;20 mg/L的CRP增加相当于风险增加1%.
- 标准的CVR评估工具往往低估了RA患者的风险.
- 改进的CVR评估方法包括修改的风险得分和特定的生物标志物.
结论:
- 炎症和自身免疫机制在RA显著增加心血管发病率和死亡率.
- RA 患者需要专门进行心血管评估.
- 带超声波可以改善心血管风险分层,特别是在RA患者中.
相关概念视频
Rheumatic Heart Disease IV: Nursing Management
272
AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
272
Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
492
The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
492
Rheumatic Heart Disease III: Medical Management
289
Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
289
Rheumatic Heart Disease I: Introduction
447
Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
447
Assessment of the Cardiovascular System I: Subjective Data
755
A thorough health history and physical assessment are essential for identifying cardiovascular disease (CVD) symptoms and distinguishing them from other health issues.
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
755
Atherosclerosis III: Management
321
Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
321


