Rheumatoid Arthritis
Özet
This chapter provides a detailed examination of the relationship between rheumatoid arthritis (RA) and cardiovascular diseases. RA is a systemic disease that affects the joints and other organs due to chronic inflammation and autoimmune mechanisms. The pathogenesis of RA involves genetic predisposition, environmental factors, and immunological processes. Clinically, it is characterized by symmetric polyarthritis, morning stiffness, and progressive joint damage.
RA not only affects the joints but also has significant impacts on the cardiovascular system, leading to serious complications such as atherosclerosis, myocardial infarction, stroke, pericarditis, valvular diseases, and heart failure. Persistent systemic inflammation, endothelial dysfunction, and excessive production of pro-inflammatory cytokines significantly increase the risk of cardiovascular disease in RA patients. Studies indicate that cardiovascular mortality in RA patients is up to 50% higher compared to the general population.
Therefore, regular monitoring of cardiovascular risk factors, effective control of inflammation, and the adoption of multidisciplinary treatment approaches are essential. Early diagnosis and appropriate treatment not only prevent joint damage but also reduce the risk of cardiovascular complications, thereby improving patients' quality of life. This chapter comprehensively explores the effects of RA on the cardiovascular system based on the latest scientific findings, aiming to raise awareness in this field.
Bu bölümde, romatoid artrit (RA) ve kardiyovasküler hastalıklar arasındaki ilişki detaylı bir şekilde ele alınmaktadır. RA, kronik inflamasyon ve otoimmün süreçlerin katkısıyla eklemleri ve diğer organları etkileyen sistemik bir hastalıktır. Hastalığın patogenezinde genetik yatkınlık, çevresel faktörler ve immünolojik mekanizmalar önemli rol oynamaktadır. Klinik olarak simetrik poliartrit, sabah tutukluğu ve ilerleyici eklem hasarı ile karakterizedir.
RA, yalnızca eklemleri değil, aynı zamanda kardiyovasküler sistemi de etkileyerek ateroskleroz, miyokard enfarktüsü, inme, perikardit, kapak hastalıkları ve kalp yetmezliği gibi ciddi komplikasyonlara neden olmaktadır. Persistan sistemik inflamasyon, vasküler endotelyal disfonksiyon ve proinflamatuvar sitokinlerin aşırı üretimi, RA hastalarında kardiyovasküler hastalık riskini belirgin şekilde artırmaktadır. Yapılan çalışmalara göre, RA hastalarında kardiyovasküler mortalite, genel popülasyona kıyasla %50’ye varan oranlarda artmaktadır.
Bu nedenle, RA hastalarının kardiyovasküler risk faktörleri açısından düzenli takip edilmesi, inflamasyonun etkin bir şekilde kontrol altına alınması ve multidisipliner tedavi yaklaşımlarının benimsenmesi büyük önem taşımaktadır. Erken tanı ve uygun tedavi, yalnızca eklem hasarını önlemekle kalmayıp, kardiyovasküler komplikasyon riskini de azaltarak hastaların yaşam kalitesini artırmaktadır. Bu kitap bölümü, RA’nın kardiyovasküler sistem üzerindeki etkilerini güncel bilimsel veriler ışığında detaylı bir şekilde ele almakta ve bu konuda farkındalığı artırmayı amaçlamaktadır.
Referanslar
Demoruelle MK, Deane KD. Rheumatoid Arthritis. Rheumatology Secrets. 15, 118-130 (2020)
McInnes I, O’Dell JR. Rheumatoid Arthritis. Goldman-Cecil Medicine. 248, 1709-1718.e2 (2020)
Firestein GS. Etiology of Rheumatoid Arthritis. Firestein & Kelly's Textbook of Rheumatology. 74, 1181-1199 (2021)
Smolen JS, Aletaha D, Barton A, et al. Rheumatoid arthritis. Nat Rev Dis Primers. 2018;4:18001. Published 2018 Feb 8. doi:10.1038/nrdp.2018.1
Terao C, Hashimoto M, Yamamoto K, et al. Three groups in the 28 joints for rheumatoid arthritis synovitis–analysis using more than 17,000 assessments in the KURAMA database. PLoS One 2013; 8: pp. e59341.
Funovits J, Aletaha D, Bykerk V, et al. The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis: methodological report phase I. Ann Rheum Dis. 2010;69(9):1589-1595. doi:10.1136/ard.2010.130310
Nishimura K, Sugiyama D, Kogata Y, et al. Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med. 2007;146(11):797-808. doi:10.7326/0003-4819-146-11-200706050-00008
Avouac J, Gossec L, Dougados M. Diagnostic and predictive value of anti-cyclic citrullinated protein antibodies in rheumatoid arthritis: a systematic literature review. Ann Rheum Dis. 2006;65(7):845-851. doi:10.1136/ard.2006.051391
Crowson C.S, Matteson E.L, Myasoedova E, et al. The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. Arthritis and rheumatism vol. 63,3 (2011): 633-9. doi:10.1002/art.30155
Avina-Zubieta J.A, Thomas J, Sadatsafavi M, et al. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies. Annals of the rheumatic diseases vol. 71,9 (2012): 1524-9. doi:10.1136/annrheumdis-2011-200726
Avina-Zubieta J.A, Choi H.K, Sadatsafavi M, et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis and rheumatism vol. 59,12 (2008): 1690-7. doi:10.1002/art.24092
Mason J.C, Libby P. Cardiovascular disease in patients with chronic inflammation: mechanisms underlying premature cardiovascular events in rheumatologic conditions. European heart journal vol. 36,8 (2015): 482-9c. doi:10.1093/eurheartj/ehu403.
Goodson N.J, Symmons D.P, Scott D.G, et al. Baseline levels of C-reactive protein and prediction of death from cardiovascular disease in patients with inflammatory polyarthritis: a ten-year followup study of a primary care-based inception cohort. Arthritis and rheumatism vol. 52,8 (2005): 2293-9. doi:10.1002/art.21204
Tomasson G, Aspelund T, Jonsson T, et al. Effect of rheumatoid factor on mortality and coronary heart disease. Annals of the rheumatic diseasesvol. 69,9 (2010): 1649-54. doi:10.1136/ard.2009.110536
Lopez-Longo F.J, Oliver-Minarro D, de la Torre I, et al. Association between anti-cyclic citrullinated peptide antibodies and ischemic heart disease in patients with rheumatoid arthritis. Arthritis and rheumatism vol. 61,4 (2009): 419-24. doi:10.1002/art.24390
Totoson P, Maguin-Gate K, Nappey M, et al. Microvascular abnormalities in adjuvant-induced arthritis: relationship to macrovascular endothelial function and markers of endothelial activation. Arthritis & rheumatology (Hoboken, N.J.) vol. 67,5 (2015): 1203-13. doi:10.1002/art.39065
Sokolove J, Brennan M.J, Sharpe O, et al. Brief report: citrullination within the atherosclerotic plaque: a potential target for the anti-citrullinated protein antibody response in rheumatoid arthritis. Arthritis and rheumatism vol. 65,7 (2013): 1719-24. doi:10.1002/art.37961
Charles-Schoeman C, Watanabe J, Lee Y.Y, et al. Abnormal function of high-density lipoprotein is associated with poor disease control and an altered protein cargo in rheumatoid arthritis. Arthritis and rheumatism vol. 60,10 (2009): 2870-9. doi:10.1002/art.24802
Elbadawi A, Ahmed H.H, Elgendy I.Y, et al. Outcomes of acute myocardial infarction in patients with rheumatoid arthritis. The American journal of medicine vol. 133,10 (2020): 1168-1179.e4. doi:10.1016/j.amjmed.2020.02.039
England BR, Mikuls TR. Clinical Features of Rheumatoid Arthritis. Firestein & Kelly's Textbook of Rheumatology. 76, 1236-1257 (2021)
Mason JC. Rheumatic Diseases and the Cardiovascular System. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 97, 1809-1828 (2022)
Romero RD, Jonas BL. Connective Tissue Diseases and the Heart. Netter’s Cardiology. 67, 476-485 (2019)
Nomeir AM, Turner RA, Watts LE. Cardiac involvement in rheumatoid arthritis: follow-up study. Arthritis and rheumatism vol. 22,6 (1979): 561-4. doi:10.1002/art.1780220601
Roldan CA, DeLong C, Qualls C, et al. Characterization of valvular heart disease in rheumatoid arthritis by transesophageal echocardiography and clinical correlates. The American journal of cardiology vol. 100,3 (2007): 496-502. doi:10.1016/j.amjcard.2007.03.048
Montani D, Henry J, O’Connell C, et al. Association between rheumatoid arthritis and pulmonary hypertension: data from the French pulmonary hypertension registry. Respiration; international review of thoracic diseases vol. 95,4 (2018): 244-250. doi:10.1159/000485631
