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Ревматоидный артрит и традиционные кардиоваскулярные факторы риска: актуальные аспекты реальной клинической практики
Трухан Д.И., Иванова Д.С., Белус К.Д. Ревматоидный артрит и традиционные кардиоваскулярные факторы риска: актуальные аспекты реальной клинической практики. Consilium Medicum. 2020; 22 (1): 19–25. DOI: 10.26442/20751753.2020.1.200052
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Trukhan D.I., Ivanova D.S., Belus K.D. Rheumatoid arthritis and traditional cardiovascular risk factors: actual aspects of real clinical practice. Consilium Medicum. 2020; 22 (1): 19–25. DOI: 10.26442/20751753.2020.1.200052
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Аннотация
Аннотация
Ревматоидный артрит – частое и одно из наиболее тяжелых иммуновоспалительных заболеваний человека, что определяет большое медицинское и социально-экономическое значение этой патологии. Одной из приоритетных проблем современной кардиоревматологии является повышенный риск сердечно-сосудистых осложнений при ревматоидном артрите. В представленном обзоре рассмотрены традиционные кардиоваскулярные факторы риска сердечно-сосудистых заболеваний (метаболический синдром, ожирение, дислипидемия, артериальная гипертензия, инсулинорезистентность, сахарный диабет, курение и гиподинамия) и генетическая предрасположенность у пациентов с ревматоидным артритом, а также их специфические особенности: «липидный парадокс» и «парадокс ожирения». Отмечено, что традиционные факторы риска сердечно-сосудистых заболеваний в определенной степени связаны и отягощены системным воспалительным процессом при ревматоидном артрите, однако эта связь предполагает проведение более подробного обзора. Взаимодействие ревматологов, кардиологов и врачей первого контакта (терапевта и врача общей практики) в изучении механизмов развития атеросклероза у больных ревматоидным артритом позволит в реальной клинической практике разработать адекватные методы своевременной диагностики и профилактики сердечно-сосудистых заболеваний у пациентов с ревматоидным артритом.
Ключевые слова: ревматоидный артрит, сердечно-сосудистые заболевания, атеросклероз, традиционные факторы риска.
Ревматоидный артрит – частое и одно из наиболее тяжелых иммуновоспалительных заболеваний человека, что определяет большое медицинское и социально-экономическое значение этой патологии. Одной из приоритетных проблем современной кардиоревматологии является повышенный риск сердечно-сосудистых осложнений при ревматоидном артрите. В представленном обзоре рассмотрены традиционные кардиоваскулярные факторы риска сердечно-сосудистых заболеваний (метаболический синдром, ожирение, дислипидемия, артериальная гипертензия, инсулинорезистентность, сахарный диабет, курение и гиподинамия) и генетическая предрасположенность у пациентов с ревматоидным артритом, а также их специфические особенности: «липидный парадокс» и «парадокс ожирения». Отмечено, что традиционные факторы риска сердечно-сосудистых заболеваний в определенной степени связаны и отягощены системным воспалительным процессом при ревматоидном артрите, однако эта связь предполагает проведение более подробного обзора. Взаимодействие ревматологов, кардиологов и врачей первого контакта (терапевта и врача общей практики) в изучении механизмов развития атеросклероза у больных ревматоидным артритом позволит в реальной клинической практике разработать адекватные методы своевременной диагностики и профилактики сердечно-сосудистых заболеваний у пациентов с ревматоидным артритом.
Ключевые слова: ревматоидный артрит, сердечно-сосудистые заболевания, атеросклероз, традиционные факторы риска.
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Abstract
Rheumatoid arthritis is a frequent and one of the most severe immuno-inflammatory diseases in humans, which determines the great medical and socio-economic importance of this pathology. One of the priority problems of modern cardiac rheumatology is an increased risk of cardiovascular complications in rheumatoid arthritis. This review discusses traditional cardiovascular risk factors for cardiovascular diseases (metabolic syndrome, obesity, dyslipidemia, hypertension, insulin resistance, diabetes mellitus, smoking and hypodynamia) and a genetic predisposition in patients with rheumatoid arthritis, as well as their specific features: "lipid paradox" and "paradox of obesity." It was noted that traditional risk factors for cardiovascular diseases are to some extent related and burdened by a systemic inflammatory process in rheumatoid arthritis, however, this relationship requires a more detailed review. The interaction of rheumatologists, cardiologists and first contact doctors (therapist and general practitioner) in studying the mechanisms of the development of atherosclerosis in patients with rheumatoid arthritis will allow in real clinical practice to develop adequate methods for the timely diagnosis and prevention of cardiovascular diseases in patients with rheumatoid arthritis.
Key words: rheumatoid arthritis, cardiovascular disease, atherosclerosis, traditional risk factors.
Характеристики
| Авторы | Д.И. Трухан / Д.С. Иванова / К.Д. Белус |
Полный текст
Список литературы
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77. De Groot L, Jager NA. Does reduction of disease activity improve early markers of cardiovascular disease in newly diagnosed rheumatoid arthritis patients? Rheumatology 2015; 54: 1257–61.
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78. Cohen Tervaert JW. Hypertension: an autoimmune disease? Hypertens Res 2011; 34 (4): 443–4.
DOI: 10.1038/hr.2011.15
79. Новикова Д.С., Попкова Т.В., Насонов Е.Л. Артериальная гипертензия при ревматоидном артрите. Научно-практическая ревматология. 2011; 49 (3): 52–68. https://doi.org/10.14412/1995-4484-2011-574
[Novikova D.S., Popkova T.V., Nasonov E.L. Arterial hypertension in rheumatoid arthritis. Rheumatology Science and Practice. 2011; 49 (3): 52–68. https://doi.org/10.14412/1995-4484-2011-574 (in Russian).]
80. Chung CP, Oeser A, Solus JF et al. Inflammation-associated insulin resistance: differential effects in rheumatoid arthritis and systemic lupus erythematosus define potential mechanisms. Arthritis Rheum 2008; 58 (7): 2105–12. DOI: 10.1002/art.23600
81. Ursini F, Russo E, D’Angelo S et al. Prevalence of undiagnosed diabetes in rheumatoid arthritis: an OGTT study. Medicine (Baltimore) 2016; 95 (7): e2552. DOI: 10.1097/MD.0000000000002552
82. Ruscitti P, Ursini F, Cipriani P et al. Prevalence of type 2 diabetes and impaired fasting glucose in patients affected by rheumatoid arthritis: results from a cross-sectional study. Medicine (Baltimore) 2017; 96 (34): e7896. DOI: 10.1097/MD.0000000000007896
83. Pi H, Zhou H, Jin H et al. Abnormal Glucose Metabolism in Rheumatoid Arthritis. Biomed Res Int 2017; 2017: 9670434. DOI: 10.1155/2017/9670434
[Clinical recommendations. Rheumatoid arthritis. Association of Rheumatologists of Russia. 2018 year. http://cr.rosminzdrav.ru/#!/recomend/173 (in Russian).]
2. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet 2016; 388 (10055): 2023–38. DOI: 10.1016/S01406736 (16)30173-8
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6. López-Longo FJ, Oliver-Miñarro D, de la Torre I et al. Association between anti-cyclic citrullinated peptide antibodies and ischemic heart disease in patients with rheumatoid arthritis. Arthritis Rheum 2009; 61 (4): 419–24. DOI: 10.1002/art.24390
7. Berendsen MLT, van Maaren MC, Arts EEA et al. Anticyclic Citrullinated Peptide Antibodies and Rheumatoid Factor as Risk Factors for 10-year Cardiovascular Morbidity in Patients with Rheumatoid Arthritis: A Large Inception Cohort Study. J Rheumatol 2017; 44 (9): 1325–30. DOI: 10.3899/jrheum.160670
8. Mavrogeni S, Dimitroulas T, Bucciarelli-Ducci C et al. Rheumatoid arthritis: an autoimmune disease with female preponderance and cardiovascular risk equivalent to diabetes mellitus: role of cardiovascular magnetic resonance. Inflamm Allergy Drug Targets 2014; 13 (2): 81–93. DOI: 10.2174/1871528113666140131151522
9. Pujades-Rodriguez M, Duyx B, Thomas SL et al. Rheumatoid Arthritis and Incidence of Twelve Initial Presentations of Cardiovascular Disease: A Population Record-Linkage Cohort Study in England. PLoS One 2016; 11 (3): e0151245. DOI: 10.1371/journal.pone.0151245. eCollection 2016.
10. Urman A, Taklalsingh N, Sorrento C, McFarlane IM. Inflammation beyond the Joints: Rheumatoid Arthritis and Cardiovascular Disease. Scifed J Cardiol 2018; 2 (3). pii: 1000019. https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC6312687/
11. Avina-Zubieta JA, Thomas J, Sadatsafavi M et al. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis 2012; 71 (9): 1524–9. DOI: 10.1136/annrheumdis-2011-200726
12. Попкова Т.В., Новикова Д.С., Насонов Е.Л. Сердечно-сосудистые заболевания при ревматоидном артрите: новые данные. Научно-практическая ревматология. 2016; 54 (2): 122–8. http://dx.doi.org/10.14412/1995-4484-2016-122-128
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58. Kurmann RD, Mankad R. Atherosclerotic vascular disease in the autoimmune rheumatologic woman. Clin Cardiol 2018; 41 (2): 258–63. DOI: 10.1002/clc.22916
59. Gobbi CA, Asbert P, Alba PB et al. Lipid profile in early arthritis and its relation with inflammatory activity. Rev Fac Cien Med Univ Nac Cordoba 2017; 74 (3): 256–62. DOI: 10.31053/1853.0605.v74.n3.16623
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62. Hollan I, Ronda N, Dessein P et al. Lipid management in rheumatoid arthritis: a position paper by the Cardiovascular Pharmacotherapy Working Group of European Society of Cardiology. Eur Heart J Cardiovasc Pharmacother 2019. pii: pvz033. DOI: 10.1093/ehjcvp/pvz033
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64. McGrath CM, Young SP. Lipid and Metabolic Changes in Rheumatoid Arthritis. Curr Rheumatol Rep 2015; 17 (9): 57. DOI: 10.1007/s11926-015-0534-z
65. Liao KP, Playford MP, Michelle F et al. The association between reduction in inflammation and changes in lipoprotein levels and HDL cholesterol efflux capacity in rheumatoid arthritis. J Am Heart Assoc 2015; 4 (2). pii: e001588. DOI: 10.1161/JAHA.114.001588
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72. Gobbi CA, Asbert P, Alba PB et al. Lipid profile in early arthritis and its relation with inflammatory activity. Rev Fac Cien Med Univ Nac Cordoba 2017; 74 (3): 256–62. DOI: 10.31053/1853.0605.v74.n3.16623
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75. Protogerou AD, Panagiotakos DB, Zampeli E et al. Arterial hypertension assessed "out-of-office" in a contemporary cohort of rheumatoid arthritis patients free of cardiovascular disease is characterized by high prevalence, low awareness, poor control and increased vascular damage-associated "white coat" phenomenon. Arthritis Res Ther 2013; 15 (5): R142. DOI: 10.1186/ar4324
76. Шилкина Н.П., Юнонин И.Е., Бутусова С.В. и др. Повреждение эндотелия и суточный профиль артериального давления при ревматоидном артрите. Терапевтический архив. 2019; 91 (5): 89–95. DOI: 10.26442/00403660.2019.05.000052
[Shilkina N.P., Yunonin I.E., Butusova S.V. et al. Endothelial damage and circadian blood pressure profile in rheumatoid arthritis. Therapeutic Archive. 2019; 91 (5): 86–95.
DOI: 10.26442/00403660.2019.05.000052 (in Russian).]
77. De Groot L, Jager NA. Does reduction of disease activity improve early markers of cardiovascular disease in newly diagnosed rheumatoid arthritis patients? Rheumatology 2015; 54: 1257–61.
DOI: 10.1093/rheumatology/keu459
78. Cohen Tervaert JW. Hypertension: an autoimmune disease? Hypertens Res 2011; 34 (4): 443–4.
DOI: 10.1038/hr.2011.15
79. Новикова Д.С., Попкова Т.В., Насонов Е.Л. Артериальная гипертензия при ревматоидном артрите. Научно-практическая ревматология. 2011; 49 (3): 52–68. https://doi.org/10.14412/1995-4484-2011-574
[Novikova D.S., Popkova T.V., Nasonov E.L. Arterial hypertension in rheumatoid arthritis. Rheumatology Science and Practice. 2011; 49 (3): 52–68. https://doi.org/10.14412/1995-4484-2011-574 (in Russian).]
80. Chung CP, Oeser A, Solus JF et al. Inflammation-associated insulin resistance: differential effects in rheumatoid arthritis and systemic lupus erythematosus define potential mechanisms. Arthritis Rheum 2008; 58 (7): 2105–12. DOI: 10.1002/art.23600
81. Ursini F, Russo E, D’Angelo S et al. Prevalence of undiagnosed diabetes in rheumatoid arthritis: an OGTT study. Medicine (Baltimore) 2016; 95 (7): e2552. DOI: 10.1097/MD.0000000000002552
82. Ruscitti P, Ursini F, Cipriani P et al. Prevalence of type 2 diabetes and impaired fasting glucose in patients affected by rheumatoid arthritis: results from a cross-sectional study. Medicine (Baltimore) 2017; 96 (34): e7896. DOI: 10.1097/MD.0000000000007896
83. Pi H, Zhou H, Jin H et al. Abnormal Glucose Metabolism in Rheumatoid Arthritis. Biomed Res Int 2017; 2017: 9670434. DOI: 10.1155/2017/9670434
________________________________________________
1. Clinical recommendations. Rheumatoid arthritis. Association of Rheumatologists of Russia. 2018 year. http://cr.rosminzdrav.ru/#!/recomend/173 (in Russian).
2. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet 2016; 388 (10055): 2023–38. DOI: 10.1016/S01406736 (16)30173-8
3. Nasonov EL. Russian clinical recommendations. Rheumatology Moscow: GEOTAR-Media, 2017. https://www.rosmedlib.ru/book/ISBN9785970442616.html (in Russian).
4. Galushko E.A., Nasonov E.L. Prevalence of rheumatic diseases in Russia. Al'manakh klin. meditsiny. 2018; 46 (1): 32–9. DOI: 10.18786/2072-0505-2018-461-32-39 (in Russian).
5. Naranjo A, Sokka T, Descalzo MA et al; QUEST-RA Group. Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study. Arthritis Res Ther 2008; 10 (2): R30. DOI: 10.1186/ar2383
6. López-Longo FJ, Oliver-Miñarro D, de la Torre I et al. Association between anti-cyclic citrullinated peptide antibodies and ischemic heart disease in patients with rheumatoid arthritis. Arthritis Rheum 2009; 61 (4): 419–24. DOI: 10.1002/art.24390
7. Berendsen MLT, van Maaren MC, Arts EEA et al. Anticyclic Citrullinated Peptide Antibodies and Rheumatoid Factor as Risk Factors for 10-year Cardiovascular Morbidity in Patients with Rheumatoid Arthritis: A Large Inception Cohort Study. J Rheumatol 2017; 44 (9): 1325–30. DOI: 10.3899/jrheum.160670
8. Mavrogeni S, Dimitroulas T, Bucciarelli-Ducci C et al. Rheumatoid arthritis: an autoimmune disease with female preponderance and cardiovascular risk equivalent to diabetes mellitus: role of cardiovascular magnetic resonance. Inflamm Allergy Drug Targets 2014; 13 (2): 81–93. DOI: 10.2174/1871528113666140131151522
9. Pujades-Rodriguez M, Duyx B, Thomas SL et al. Rheumatoid Arthritis and Incidence of Twelve Initial Presentations of Cardiovascular Disease: A Population Record-Linkage Cohort Study in England. PLoS One 2016; 11 (3): e0151245. DOI: 10.1371/journal.pone.0151245. eCollection 2016.
10. Urman A, Taklalsingh N, Sorrento C, McFarlane IM. Inflammation beyond the Joints: Rheumatoid Arthritis and Cardiovascular Disease. Scifed J Cardiol 2018; 2 (3). pii: 1000019. https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC6312687/
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Авторы
Д.И. Трухан*, Д.С. Иванова, К.Д. Белус
ФГБОУ ВО «Омский государственный медицинский университет» Минздрава России, Омск, Россия
*dmitry_trukhan@mail.ru
ФГБОУ ВО «Омский государственный медицинский университет» Минздрава России, Омск, Россия
*dmitry_trukhan@mail.ru
________________________________________________
Dmitry I. Trukhan*, Darya S. Ivanova, Kristina D. Belus
Omsk State Medical University, Omsk, Russia
*dmitry_trukhan@mail.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.