Long-term rheumatoid arthritis associated with accelerated atherosclerosis

מתוך medicontext.co.il
NEW YORK (Reuters Health) – Atherosclerotic manifestations in patients with rheumatoid arthritis (RA) of approximately 20 years' duration are worse than those of age- and sex-matched control subjects. The increased progression appears to be related not so much to inflammatory mediators as to blood lipid levels, the investigators report.

Thirty-nine patients who had RA onset 19 to 23 years previously and were younger than 65 years old were compared with 39 control subjects. The findings are reported in The Journal of Rheumatology for December.

The results of B-mode ultrasonography of the common carotid artery, Dr. Solveig Wallberg-Jonsson, and colleagues at the University Hospital of Umea in Sweden, found that the intima-media thickness was significantly greater in the RA group. This measurement was associated with cholesterol, LDL, LDL/HDL ratio, triglycerides, and tissue plasminogen activator antigen.

Echocardiography showed evidence of aortic cusp sclerosis/stenosis in 11 patients and 3 control subjects. Again, the adverse finding was related to higher cholesterol and triglyceride levels, as well as soluble intercellular adhesion molecule 1.

The Swedish researchers suggest that the association between rheumatoid arthritis and atherosclerotic progression may result from continuous endothelial activation or dysfunctional vasculature that is more affected by traditional cardiovascular risk factors.

"It seems urgent that in addition to the treatment of their arthritis these patients should be screened, and adequately treated for, other cardiovascular risk factors, particularly presence of hyperlipidemia, even when not at extreme levels," Dr. Wallberg-Jonsson's team advises.

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