脊椎关节炎合并症患者的最佳管理:关注心血管安全

D. Karateev, E. Luchikhina, E. Markelova
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摘要

一般来说,风湿病(RD)的合并症和多病是典型的。合并症对RD患者有复杂的负面影响:它们通常是患者过早死亡的直接原因,它们可能导致炎症过程的严重过程,合并症减少了治疗方案的选择。脊柱炎,如银屑病关节炎(PsA)和轴性脊柱炎(axSpA),也以经常存在合并症为特征,特别是心血管疾病。促炎细胞因子如白细胞介素17A (IL-17A)的多效性促进了这些过程。IL-17A是一种多功能的促炎T细胞细胞因子。同时,有证据表明IL-17参与了许多其他病理过程:骨组织重塑、内皮功能障碍的发展、不稳定动脉粥样硬化斑块的形成、缺血性发作后心室重塑等。临床数据证实了IL-17A的过量产生在心血管疾病发展中的作用。以Secukinumab IL-17A抑制PsA和axSpA为例,已经证明这种治疗与高水平的心血管安全性相关,并且可能有助于降低心血管风险。IL-17A抑制剂治疗,特别是Secukinumab治疗,结合普遍接受的传统心血管危险因素纠正方法,可能是SpA患者和伴随心血管疾病管理的一个有希望的方向
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Optimal Management of Comorbid Patients with Spondyloarthritis: Focus on Cardiovascular Safety
Comorbidity and multimobidity are typical for rheumatic diseases (RD) in general. Comorbidities have a complex negative impact on the patient with RD: they are often a direct cause of the premature death of patients, they may contribute to the severe course of the inflammatory process, comorbidities reduce choice of treatment options. Spondyloarthritis, such as psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), is also characterized by the frequent presence of comorbid conditions, in particular, cardiovascular diseases. Pleiotropic effects of pro-inflammatory cytokines such as interleukin 17A (IL-17A) promote these processes. IL-17A is a versatile pro-inflammatory T cell cytokine. At the same time, there is evidence that IL-17 involved in many other pathological processes: bone tissue remodeling, the development of endothelial dysfunction, formation of the unstable atherosclerotic plaques, heart ventricle remodeling after ischemic attack, etc. Clinical data confirm the role of hyperproduction of IL-17A in the development of cardiovascular diseases. On the example of Secukinumab IL-17A inhibition in PsA and axSpA, it has been shown that this treatment is associated with a high level of cardiovascular safety, and it is likely may help reduce cardiovascular risk. Therapy with IL-17A inhibitors, in particular, Secukinumab, in combination with generally accepted methods of correction of traditional cardiovascular risk factors, may be a promising direction in the management of patients with SpA and concomitant cardiovascular diseases
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