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The lipid paradox in rheumatoid arthritis: the dark horse of the augmented cardiovascular risk

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Abstract

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation that, if left untreated, can cause joint destruction and physical impairments. The inflammatory process is systematic, and it is associated with increased morbidity and mortality. Over the last years, mortality presents a decreasing trend; still, there is a high burden of cardiovascular disease (CVD) in RA that seems to be related to coronary atherosclerosis. Chronic inflammation, physical inactivity, and drugs used to treat RA are some of the reasons. Thus, the management of CVD risk is essential and involves the patient's stratification using distinct parameters that include assessment of the blood lipid profile. However, 'dyslipidemia' in RA patients follows a different pattern under the impact of inflammatory processes, while therapies that target the underlying disease change the levels of specific lipid components. In this review, we explore the relationship between blood lipids and inflammation in the so-called ΄lipid paradox΄ in RA, and we present the existing knowledge over the influence of antirheumatic drugs on the lipid profile of RA patients.

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Abbreviations

ACPA:

Anti-cyclic citrullinated protein antibodies

apo A-I:

Apolipoprotein A-I

ABCA1:

ATP-binding cassette transporter A1

ABCG1:

ATP-binding cassette transporter G1 (ABCG1)

apo A-II:

Apolipoprotein A-II

apo B-48:

Apolipoprotein B-48

apo B:

Apolipoprotein B-100

b:

Biological

CETP:

Cholesteryl ester transfer protein

CHD:

Coronary heart disease

CHOL:

Cholesterol

CRP:

C-reactive protein

CVD:

Cardiovascular disease

Cs:

Conventional synthetic

DAS-28:

Disease Activity Score-28 for Rheumatoid Arthritis

DMARDs:

Disease-modifying antirheumatic drugs

ESR:

Erythrocyte sedimentation rate

EULAR:

European League Against Rheumatism

HDL:

High-density lipoproteins

HDL-C:

High-density lipoprotein cholesterol

HCQ:

Hydroxychloroquine

IDL:

Intermediate-density lipoproteins

IL-6:

Interleukin-6

JAK inhibitors:

Janus kinase inhibitors

LDL:

Low-density lipoproteins

LDL-C:

Low-density lipoprotein cholesterol

LDL-C:

Low-density lipoprotein cholesterol

LDLR:

LDL receptor

LCAT:

Lecithin cholesterol acyltransferase

Lp(a):

Lipoprotein(a)

LPL:

Lipoprotein lipase

FCR:

Fractional catabolic rate

FFA:

Free fatty acids

MTX:

Methotrexate

Ox-LDL:

Oxidized LDL

PON:

Paraoxonase

RA:

Rheumatoid arthritis

RF:

Rheumatoid factor

RChT:

Reverse cholesterol transport

RTX:

Rituximab

SR-B1:

Class-B-scavenger receptor B1

TC:

Total cholesterol

TGs:

Triglycerides

TNF-a:

Tumor necrosis factor-alpha

VLDL:

Very low-density lipoproteins

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  1. Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110, Ioannina, Greece

    Aliki I. Venetsanopoulou, Eleftherios Pelechas, Paraskevi V. Voulgari & Alexandros A. Drosos

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  2. Eleftherios Pelechas
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All authors made substantial contributions and approved the final version of the manuscript. (AIV and EP: drafting; PVV: review; AAD: conception and design of the work, review).

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Venetsanopoulou, A.I., Pelechas, E., Voulgari, P.V. et al. The lipid paradox in rheumatoid arthritis: the dark horse of the augmented cardiovascular risk. Rheumatol Int 40, 1181–1191 (2020). https://doi.org/10.1007/s00296-020-04616-2

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