The Cardiovascular Burden of Rheumatoid Arthritis - Implications for Treatment

Mortality in rheumatoid arthritis is increased, about twice vs controls, and cardiovascular diseases are a major cause. The pathogenesis is primarily accelerated atherosclerosis of the coronary, cervical, and cere-bral arteries, which is premature, pervasive, and progressive, but often occult, under-recognized, and under-treated. It is mostly driven by the chronic, systemic autoimmune inflammation, but increased preva-lence of traditional risk factors and adverse effects of treatments are also very important. Inflammatory markers, disease severity, and duration are major determinants of the cardiovascular risk in rheumatoid arthritis, which is underestimated by usual methods. Cardiovascular protection is best achieved by sup-pressing inflammation and disease activity as early as possible (treat-to-target), and striving to achieve and maintain remission or lowest disease activity. Secondly, identifying and addressing the whole spec-trum of traditional risk factors, currently often neglected, is necessary. Because long-term glucocorticoid exposure >= 5 mg/d may be associated with cardiovascular events and other harm, more intensive treatment, especially useful for bridging with methotrexate at the outset of treatment, needs to be limited in time and dosage. A multipronged approach may improve cardiovascular outcomes of RA patients in future studies. (c) 2023 Elsevier Inc. All rights reserved. center dot The American Journal of Medicine (2023) 136:1143-1146

Automated summary

Mortality is increased in rheumatoid arthritis, primarily due to cardiovascular diseases. The pathogenesis involves accelerated atherosclerosis and chronic inflammation. The best cardiovascular protection is achieved by early suppression of inflammation and disease activity, as well as addressing traditional risk factors.