一项横断面研究表明RA达标治疗有利于降低心血管风险

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Ann Rheum Dis 2011;70:812-817 doi:10.1136/ard.2010.141523 Remission is the goal for cardiovascular risk management in patients with rheumatoid arthritis: a cross-sectional comparative study 1.       Sella A Provan1, 2.       Anne Grete Semb1, 3.       Jonny Hisdal2, 4.       Einar Stranden2, 5.       Stefan Agewall3, 6.       Hanne Dagfinrud1, 7.       Kristin Angel3, 8.       Dan Atar4, 9.       Tore K Kvien1 Abstract Objectives To compare markers of cardiovascular disease (CVD) risk between patients with rheumatoid arthritis (RA) in an active disease state and those with RA in remission, and to compare both groups with community controls. Methods 113 patients with RA and 86 community controls were assessed across a panel of biomarkers for CVD. RA in remission was defined as Clinical Disease Activity Index ≤2.8. Community controls were selected at random by Statistics Norway, and controls were matched with patients in the cohorts in strata using details of age, sex and residential area. A panel of biomarkers (N-terminal pro-brain natriuretic peptide (NT-proBNP), total cholesterol, reactive hyperaemia index (RHI), pressure measurements, measures of arterial stiffness and intima-media thickness) were compared between patients with active RA and those with RA in remission. Both groups were compared with controls. In addition, biomarker levels were compared across subgroups based on anticyclic citrullinated peptide status, level of joint destruction and presence of extra-articular manifestations. Results Patients with active RA had significantly higher levels of NT-proBNP, brachial systolic pressure, augmentation index and central systolic pressure but lower cholesterol than patients in remission and controls. In addition, patients with active RA had significantly higher levels of pulse wave velocity and worse RHI than patients in remission. Comparison across other subgroups gave less consistent differentiations in levels of CVD risk markers. Conclusion Patients with active RA, but not those in remission, had significantly increased levels of CVD risk markers. These results link inflammatory activity to markers of CVD risk in patients with RA and may indirectly support the notion that remission in RA confers diminished cardiovascular morbidity.

一项横断面研究表明RA达标治疗有利于降低心血管风险 Provan SA, et al. Ann Rheum Dis. 2011;70: 812-7.   目的: 比较分别处于疾病活动和临床缓解状态下的RA病人心血管疾病（CVD）发生风险相关的标志物，并与社区病人作对比。 方法: 对113例RA和86个社区对照者进行一组心血管疾病生物标志物的检测。RA缓解的定义为CDAI≤2.8。通过挪威统计局随机选取了社区对照者，他们与RA病人队列的年龄，性别和居住区相匹配。比较活动性与缓解性RA病人在以下生物标志物的差异，包括N端脑利钠肽前体(NT-proBNP)、总胆固醇，反应性充血指数(RHI)、血压、动脉硬化和颈动脉内中膜厚度。将这两组RA病人的上述参数与对照组进行比较。此外，基于抗CCP抗体、关节破坏和关节外表现，对上述生物学标记进行亚组分析。 结果: 活动性RA病人的NT-proBNP、肱动脉收缩压、桡动脉反射波增益指数和中心动脉收缩压显著高于缓解病人和对照者，而胆固醇较低。另外，与缓解病人相比，活动性RA病人的脉搏波传导速度(PWV)较快、RHI较差。亚组分析并未发现CVD风险标记物有一致变化趋势。 结论: 活动性RA，而非RA缓解者，的CVD风险标记物水平显著升高。这些发现将炎性活动度与RA心血管风险联系起来，简洁地支持了RA治疗目标定为缓解将有助于降低心血管并发症的发生风险。