Cardiovascular disease is a leading cause of mortality in rheumatoid arthritis (RA).
Endothelial dysfunction often precedes manifest atherosclerosis. Both traditional,
Framingham risk factors and inflammation-associated factors are involved in RA-associated
atherosclerosis. Among imaging techniques, the early determination of common carotid
intima-media thickness (ccIMT), flow-mediated vasodilation (FMD), and nitroglycerine-mediated
vasodilation (NMD) may be useful to determine atherosclerosis and endothelial dysfunction.
We and others found increased ccIMT and impaired FMD in RA patients. Among immunological
and metabolic laboratory markers, anticyclic citrullinated peptide (anti-CCP) antibodies,
IgM rheumatoid factor, circulating immune complexes, pro-inflammatory cytokines including
tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6), Th0/Th1 T cells,
homocysteine, dyslipidemia, decreased folate and vitamin B12 production, and impaired
paraoxonase activity may all be involved in the development of vascular disease in
RA. The early diagnosis of endothelial dysfunction and atherosclerosis, active immunosuppressive
treatment, the use of drugs that control atherosclerosis, changes in sedentary lifestyle,
and the close follow-up of RA patients may help to minimize cardiovascular risk in
these individuals.
