Risk factors and early detection of atherosclerosis in rheumatoid arthritis


L. de Groot, Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ or PO Box 30·001, 9700 RB, Groningen, the Netherlands. Tel.: (31) 50-3613432; fax: (31) 50-3619308; e-mail: lodewijk.de.groot@int.umcg.nl


Eur J Clin Invest 2010; 40 (9): 835–842


Background  Patients with rheumatoid arthritis (RA) have an increased morbidity and mortality due to cardiovascular disease (CVD). This cannot be explained alone by the increased prevalence of traditional cardiovascular risk factors like smoking and hypertension. Other factors therefore seem to be involved in the pathogenesis of atherosclerosis in RA.

Methods  Literature was searched for epidemiology and pathophysiology of atherosclerosis in RA, with special focus on the role of advanced glycation end products (AGE’s), endothelial activation, endothelial dysfunction and premature atherosclerosis as measured by intima media thickness (IMT). Finally, a literature search was performed on therapeutic strategies to prevent atherosclerosis in RA.

Results  In RA increased AGE accumulation, endothelial activation, endothelial dysfunction and premature atherosclerosis can be identified. Treatment of RA activity by multiple disease modifying anti rheumatic drugs (DMARD’s) has shown to be effective in reducing premature atherosclerosis in RA.

Conclusion  Cardiovascular disease is increased in RA. Tight disease control and treatment of other risk factors is recommended to prevent morbidity and mortality due to CVD in RA.