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a Division of Rheumatology, and Third Department of Medicine, University of Debrecen Medical and Health Science Center, Debrecen, Hungary b Cardiovascular Unit, Third Department of Medicine, University of Debrecen Medical and Health Science Center, Debrecen, Hungary c Department of Rheumatology, Szent Ferenc Hospital, Miskolc, Hungary d Research Center for Autoimmune Diseases, Hungarian Academy of Sciences, Debrecen, Hungary e Department of Medicine B and Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
Key Words: rheumatoid arthritis • endothelial dysfunction • atherosclerosis
Address for correspondence: Zoltán Szekanecz, M.D., Ph.D., Third Department of Internal Medicine, Rheumatology Division, University of Debrecen, Medical and Health Science Center, Móricz Zs krt. 22., H-4004 Debrecen, Hungary. Voice: +36-52-314-091; fax: +36-52-414-489. szekanecz{at}iiibel.dote.hu
Cardiovascular disease is a leading cause of mortality in rheumatoid arthritis (RA). Endothelial dysfunction often precedes manifest atherosclerosis. Both traditional, Framingham risk factors and inflammation-associated factors are involved in RA-associated atherosclerosis. Among imaging techniques, the early determination of common carotid intima-media thickness (ccIMT), flow-mediated vasodilation (FMD), and nitroglycerine-mediated vasodilation (NMD) may be useful to determine atherosclerosis and endothelial dysfunction. We and others found increased ccIMT and impaired FMD in RA patients. Among immunological and metabolic laboratory markers, anticyclic citrullinated peptide (anti-CCP) antibodies, IgM rheumatoid factor, circulating immune complexes, pro-inflammatory cytokines including tumor necrosis factor-
 (TNF-) and interleukin-6 (IL-6), Th0/Th1 T cells, homocysteine, dyslipidemia, decreased folate and vitamin B12 production, and impaired paraoxonase activity may all be involved in the development of vascular disease in RA. The early diagnosis of endothelial dysfunction and atherosclerosis, active immunosuppressive treatment, the use of drugs that control atherosclerosis, changes in sedentary lifestyle, and the close follow-up of RA patients may help to minimize cardiovascular risk in these individuals.
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