Inflammation beyond the Joints: Rheumatoid Arthritis and Cardiovascular Disease.

Abstract

Rheumatoid Arthritis (RA), a chronic systemic inflammatory disease which affects approximately 1% of the population, is classically characterized by inflammation and synovitis that leads to cartilage damage and juxta-articular bone destruction. Accumulating evidence indicates that a major cause of death among RA patients is Cardio Vascular Disease (CVD), in excess of that in the general population. In this review, we discuss the epidemiology of CVD in RA populations, the underlying pathophysiologic mechanisms of CVD in RA including the role of chronic inflammation in driving accelerated atherosclerosis, the obesity paradox and altered metabolic pathways leading to pro-inflammatory HDL formation and insulin resistance. We also discuss the pitfalls in the evaluation of CVD utilizing traditional risk scores which tend to underestimate CVD risk in RA population and the efforts directed to find more accurate predictors for early CVD detection. Finally, we will present the latest developments in the evaluation and management of CVD in RA patients, given recent evidence on the role of inflammation and its impact on CVD.