Autoimmune atherosclerosis in 3D: How it develops, how to diagnose and what to do.

Autoimmune-inflammatory rheumatic diseases, such as rheumatoid arthritis (RA) have been associated with autoimmune atherosclerosis leading to increased cardiovascular risk. Traditional risk factors, genetics, as well as the role of systemic inflammation including inflammatory cells, cytokines, chemokines, proteases, autoantibodies, adhesion receptors and others have been implicated in the development of these vascular pathologies. Cardiovascular risk may be determined by the use of currently available tools. In addition, non-invasive assessment of vascular pathophysiology by imaging, as well as laboratory biomarkers can help to refine risk assessment. With respect to prevention and therapy, traditional vasculoprotection using statins, ACE inhibitors, aspirin should be applied to patients at risk. Non-steroidal antiinflammatory drugs and corticosteroids may be pro-atherogenic, on the other hand, they may also be beneficial due to their anti-inflammatory nation. Traditional and biologic DMARDs may have significant vascular and metabolic effects. Decreasing inflammatory activity by any of these agents may lead to better CV outcome. The official EULAR recommendations on the assessment and management of cardiovascular disease in arthritides may guide the rheumatologist during the process of CV screening, prevention and treatment.

Rheumatoid arthritis and metabolic syndrome.

Rheumatoid arthritis (RA), especially active disease, is associated with considerable changes in body composition, lipids, adipokines and insulin sensitivity. Metabolic changes, such as increased total cholesterol, LDL cholesterol and triglyceride levels, occur even in preclinical RA. Active RA is associated with decreased lipid levels, BMI, fat and muscle mass, as well as altered lipid profiles. Some of these changes are also seen in metabolic syndrome, and could increase cardiovascular mortality. Importantly, the systemic inflammation underlying RA is an independent risk factor for cardiovascular disease. This Perspectives article summarizes data on the associations of various components of metabolic syndrome with RA, and discusses the effects of biologic therapy on these factors. The authors propose that components of metabolic syndrome should be monitored in patients with RA throughout the disease course, and argue that optimal disease control using biologic agents might attenuate several adverse effects of metabolic syndrome in these patients.