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Atheroskleroserisiko durch Inflammation bei rheumatoider Arthritis

Risk of atherosclerosis mediated by inflammation in rheumatoid arthritis

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Zusammenfassung

Die systemische Entzündungsreaktion stellt ein zentrales pathogenetisches Prinzip für die Entstehung und Progression einer Atherosklerose dar. Bei der rheumatoiden Arthritis (RA) besteht ein erheblich erhöhtes kardiovaskuläres Risiko, das durch klassische kardiovaskuläre Risikofaktoren alleine nicht erklärt ist, sondern vermutlich durch eine chronische systemische Entzündungsreaktion. Eine rasche und möglichst komplette Kontrolle der Krankheitsaktivität bietet nach gegenwärtiger Auffassung die beste Voraussetzung für eine Normalisierung des kardiovaskulären Risikos des einzelnen Patienten, auch wenn diese Hypothese bisher noch nicht durch prospektive kontrollierte Studien belegt ist. Daneben haben Identifizierung und Behandlung konventioneller Risikofaktoren bei RA-Patienten nach wie vor einen hohen Stellenwert, da die Primärprophylaxe nachweislich die Mortalität bei RA-Patienten senkt. Unklar ist jedoch, wer diese Aufgaben im medizinischen Alltag angesichts der zuweilen aufwendigen Patienten und zeitlich und finanziell limitierten Ressourcen wahrnehmen kann.

Abstract

Systemic inflammation is one of the pivotal pathogenetic principles in atherogenesis and progression of atherosclerosis. Patients with rheumatoid arthritis (RA) exhibit an increased cardiovascular risk that is not explained by traditional cardiovascular risk factors but rather by a chronic systemic inflammatory reaction. Reduction of inflammatory activity in RA patients was shown to reduce cardiovascular morbidity and mortality. Besides this specific approach traditional cardiovascular risk factors need to be carefully controlled in order to improve mortality in RA patients; however, this task is difficult to implement in everyday practice as RA patients usually have decisively different medical needs that need to be addressed irrespective of the well-acknowledged limitations of medical resources, such as time and costs.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: S. Kleinert: Berater- oder Referentenhonorare durch die Firmen Roche, Abbott, Chugai. K. Krüger: Berater- und Referentenhonorare durch die Firmen Abbott und Roche. S. Störk: Referentenhonorare durch die Firmen Roche, Chugai.

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Authors and Affiliations

  1. Rheumatologie/Klinische Immunologie, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland

    S. Kleinert

  2. Praxiszentrum St. Bonifatius München, München, Deutschland

    K. Krueger

  3. Deutsches Zentrum für Herzinsuffizienz Würzburg, Universität Würzburg, Würzburg, Deutschland

    S. Störk

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  1. S. Kleinert
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  2. K. Krueger
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Correspondence to S. Kleinert.

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Kleinert, S., Krueger, K. & Störk, S. Atheroskleroserisiko durch Inflammation bei rheumatoider Arthritis. Z. Rheumatol. 71, 850–858 (2012). https://doi.org/10.1007/s00393-011-0923-2

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