Conventional Disease-Modifying Antirheumatic Drugs (DMARDs)
Özet
In individuals with rheumatologic diseases, the risk of cardiovascular disease (CVD) is increased due to systemic inflammation, traditional cardiovascular risk factors, reduced physical activity, and the potential adverse effects of antirheumatic treatments. Conventional disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine play a crucial role in disease control and can directly influence cardiovascular outcomes. For example, although methotrexate has raised concerns due to its potential to cause hyperhomocysteinemia, this adverse effect can be prevented with folate supplementation, and methotrexate has been shown to reduce cardiovascular mortality through anti-inflammatory, antioxidative, and metabolic mechanisms. Leflunomide exhibits both anti-inflammatory and cardioprotective effects, but may cause an early increase in blood pressure. Sulfasalazine presents a neutral cardiovascular profile, with potential indirect benefits by reducing vascular inflammation. Hydroxychloroquine may lower CVD risk by improving lipid and glucose metabolism; however, rare but serious adverse effects such as cardiomyopathy and QT prolongation have been reported. Other immunosuppressants, including azathioprine, cyclophosphamide, and calcineurin inhibitors, may increase CVD risk through mechanisms such as endothelial dysfunction and hypertension. In conclusion, conventional DMARDs may exert beneficial effects on CVD by controlling inflammation; however, careful monitoring and individualized risk assessment are essential due to potential adverse effects.
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