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Rheumatoide Arthritis

Systemische Entzündung und kardiovaskuläre Morbidität

Rheumatoid arthritis

Systemic inflammation and cardiovascular morbidity

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Zusammenfassung

In den letzten Jahren ist die Erkenntnis gereift, dass eine systemische Entzündung, wie sie typischerweise bei chronisch-entzündlich rheumatischen Erkrankungen auftritt, signifikant zu dem bei diesen Erkrankungen deutlich gesteigerten kardiovaskulären Risiko mit der entsprechenden zusätzlichen Morbidität und Mortalität beiträgt. Autoimmunerkrankungen und Atherosklerose unterliegen hierbei den gleichen Spielregeln der systemischen Entzündung und weisen multiple pathophysiologische und klinische Parallelen auf. Aus rheumatologischer Sicht ist die rheumatoide Arthritis als eine der Erkrankungen mit Prototypcharakter zu nennen. Da eine konsequente therapeutische Hemmung der systemischen Entzündung bei der rheumatoiden Arthritis vice versa zu einem deutlich reduzierten kardiovaskulären Risiko führt, ist sowohl die engmaschige rheumatologische und kardiologische Überwachung der gefährdeten Patienten als auch die konsequente Therapie mit konventionellen krankheitsmodifizierenden Medikamenten und Biologika unbedingt anzustreben.

Abstract

In recent years it could be shown that systemic inflammation, which typically occurs in chronic inflammatory rheumatic diseases, significantly contributes to cardiovascular morbidity and mortality. All rheumatic diseases inherit this enhanced risk for cardiovascular complications with rheumatoid arthritis being one of the most prominent. As the underlying pathophysiological mechanisms are very similar with respect to endothelial damage all rheumatic diseases and specifically rheumatoid arthritis should be monitored and treated with disease-modifying drugs and biological agents as consistently as possible to be able to improve the long-term outcome of affected patients as much as possible.

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Literatur

  1. Boyle JJ (2005) Macrophage activation in atherosclerosis: pathogenesis and pharmacology of plaque rupture. Curr Vasc Pharmacol 3:63–68

    Article  PubMed  CAS  Google Scholar 

  2. Danesh J, Wheeler JG, Hirschfield GM et al (2004) C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med 350:1387–1397

    Google Scholar 

  3. Danett KB et al (2006) ICAM-1 expression in adipose tissue: effects of diet-induced obesity in mice. Am J Physiol Cell Physiol 291:1232–239

    Google Scholar 

  4. Fisman EZ, Adler Y, Tenenbaum A (2008) Biomarkers in cardiovascular diabetology: interleukins and matrixins. Adv Cardiol 45:44–64

    Article  PubMed  CAS  Google Scholar 

  5. Gullestad L, Ueland T, Vinge LE et al (2012) Inflammatory cytokines in heart failure: mediators and markers. Cardiology 122:23–35

    Article  PubMed  CAS  Google Scholar 

  6. Gadola SD (2012) In: Peter HH, Pichler WJ, Müller-Ladner U (Hrsg) Klinische Immunologie. Urban & Fischer, München, S 7–25

  7. González-Juanatey C, Llorca J, González-Gay MA (2011) Correlation between endothelial function and carotid atherosclerosis in rheumatoid arthritis patients with long-standing disease. Arthritis Res Ther 13:R101

    Article  PubMed  Google Scholar 

  8. Hjeltnes G et al (2011) Anti-CCP und RF-IgM: predictors of impaired endothelial function in rheumatoid arthritis patients. Scand J Rheumatol 40:422–427

    Article  PubMed  CAS  Google Scholar 

  9. Klimiuk PA et al (2002) Soluble adhesion molecules (ICAM-1, VCAM-1, and E-selectin) and vascular endothelial growth factor (VEGF) in patients with distinct variants of rheumatoid synovitis. Ann Rheum Dis 61:804–809

    Article  PubMed  CAS  Google Scholar 

  10. Kwak BR, Mach F (2001) Statins inhibit leukocyte recruitment: new evidence for their anti-inflammatory properties. Arterioscler Thromb Vasc Biol 21:1256–1258

    PubMed  CAS  Google Scholar 

  11. Tam LS et al (2012) Infliximab is associated with improvement in arterial stiffness in patients with early rheumatoid arthritis—a randomized trial. J Rheumatol 39:2267–2275

    Google Scholar 

  12. Murdaca G et al (2012) Endothelial dysfunction in rheumatic autoimmune diseases. Atherosclerosis 224:309–317

    Article  PubMed  CAS  Google Scholar 

  13. Mellana WM et al (2012) Rheumatoid arthritis: cardiovascular manifestations, pathogenesis, and therapy. Curr Pharm Des 18:1450–1456

    Article  PubMed  CAS  Google Scholar 

  14. Maron DJ, Fazo S, Linton MF (2000) Current perspectives on statins. Circulation 101:207–213

    Article  PubMed  CAS  Google Scholar 

  15. Miranda-Filloy JA, Llorca J (2012) TNF-α antagonist therapy improves insulin sensitivity in non-diabetic ankylosing spondylitis patients. Clin Exp Rheumatol 30:850–855

    PubMed  Google Scholar 

  16. Meek IL et al (2013) Increased cardiovascular risk factors in different rheumatic diseases compared with the general population. Rheumatology 52:210–216

    Article  PubMed  Google Scholar 

  17. Moller DE (2000) Potential role of TNF-alpha in the pathogenesis of insulin resistance and type 2 diabetes. Trends Endocrinol Metab 11:212–217

    Article  PubMed  CAS  Google Scholar 

  18. Moutzouri E, Tellis CC et al (2012) Effect of simvastatin or its combination with ezetimibe on Toll-like receptor expression and lipopolysaccharide-induced cytokine production in monocytes of hypercholesterolemic patients. Atherosclerosis 225:381–387

    Article  PubMed  CAS  Google Scholar 

  19. Mason RP (2011) Optimal therapeutic strategy for treating patients with hypertension and atherosclerosis: focus on olmesartan medoxomil. Vasc Health Risk Manag 7:405–416

    Article  PubMed  Google Scholar 

  20. Peters MJ et al (2010) Tumour necrosis factor (alpha) blockade reduces circulating N-terminal pro-brain natriuretic peptide levels in patients with active rheumatoid arthritis: results from a prospective cohort study. Ann Rheum Dis 69:1281–1285

    Article  PubMed  CAS  Google Scholar 

  21. Peters MJ et al (2012) The effects of tumor necrosis factor inhibitors on cardiovascular risk in rheumatoid arthritis. Curr Pharm Des 18:1502–1511

    Article  PubMed  CAS  Google Scholar 

  22. Peters MJ et al (2010) EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 69:325–331

    Article  PubMed  CAS  Google Scholar 

  23. Pham TN, Rahman P et al (2003) Elevated serum nitric oxide levels in patients with inflammatory arthritis associated with co-expression of inducible nitric oxide synthase and protein kinase C-eta in peripheral blood monocyte-derived macrophages. J Rheumatol 30:2529–2534

    Google Scholar 

  24. Qamar A, Rader DJ (2012) Effect of interleukin 1β inhibition in cardiovascular disease. Curr Opin Lipidol 23:548–553

    Article  PubMed  CAS  Google Scholar 

  25. Rohde LE (1999) Survey of C-reactive protein and cardiovascular risk factors in apparently healthy men. Am J Cardiol 84:1018–1022

    Article  PubMed  CAS  Google Scholar 

  26. Ridker PM et al (2000) C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 342:836–843

    Google Scholar 

  27. Ridker PM (2009) Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial. Lancet 373:1175–1182

    Article  PubMed  CAS  Google Scholar 

  28. Robert Koch-Institut (2010) GEDA-Studie

  29. Ross R (1999) Atherosclerosis—an inflammatory disease. N Engl J Med 340:115–126

    Google Scholar 

  30. Scholze-Koops H (2012) In: Peter HH, Pichler WJ, Müller-Ladner U (Hrsg) Klinische Immunologie. Urban & Fischer, München, S 265–267

  31. Solomon DH et al (2006) Patterns of cardiovascular risk in rheumatoid arthritis. Ann Rheum Dis 65:1608–1612

    Article  PubMed  CAS  Google Scholar 

  32. Shizu M et al (2008) Cigarette smoke condensate upregulates the gene and protein expression of proinflammatory cytokines in human fibroblast-like synoviocyte line. J Interferon Cytokine Res 28:509–521

    Google Scholar 

  33. Sugimoto H et al (1997) Increased expression of intercellular adhesion molecule-1 (ICAM-1) in diabetic rat glomeruli: glomerular hyperfiltration is a potential mechanism of ICAM-1 upregulation. Diabetes 46:2075–2081

    Article  PubMed  CAS  Google Scholar 

  34. Schuett H, Luchtefeld M et al (2009) How much is too much? Interleukin-6 and its signalling in atherosclerosis. Thromb Haemost 102:215–222

    PubMed  CAS  Google Scholar 

  35. Spranger J, Kroke A et al (2003) Inflammatory cytokines and the risk to develop type 2 diabetes: results of the prospective population-based European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study. Diabetes 52:812–817

    Article  PubMed  CAS  Google Scholar 

  36. Solomon DH et al (2010) Explaining the cardiovascular risk associated with rheumatoid arthritis: traditional risk factors versus markers of rheumatoid arthritis severity. Ann Rheum Dis 69:1920–1925

    Article  PubMed  Google Scholar 

  37. Tetè S, Tripodi D et al (2012) Endothelial cells, cholesterol, cytokines, and aging. Int J Immunopathol Pharmacol 25:355–363

    PubMed  Google Scholar 

  38. Van Doornum S (2010) Rheumatoid arthritis patients receive less frequent acute reperfusion and secondary prevention therapy after myocardial infarction compared with the general population. Arthritis Res Ther 12:R183

    Article  Google Scholar 

  39. Vaudo G et al (2004) Endothelial dysfunction in young patients with rheumatoid arthritis and low disease activity. Ann Rheum Dis 63:31–35

    Article  PubMed  CAS  Google Scholar 

  40. Vaughan CJ, Gotto AM, Basson CT (2000) The evolving role of statins in the management of atherosclerosis. J Am Coll Cardiol 35:1–10

    Google Scholar 

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Interessenkonflikt

Die korrespondierende Autorin weist für sich und ihren Koautor auf folgende Beziehungen hin: E. Decker: Honorar für Referententätigkeit und Reisekostenübernahme durch Fa. Pfizer, Reisekostenübernahme durch Fa. MSD-Essex. U. Müller-Ladner: Sprecher und/oder Berater der Hersteller der im Text genannten Biologika.

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Authors and Affiliations

  1. Abteilung für Rheumatologie und klinische Immunologie, Kerckhoff-Klinik GmbH, Benekestr. 2–8, 61231, Bad Nauheim, Deutschland

    E. Decker

  2. Kerckhoff-Klinik GmbH, Bad Nauheim, Deutschland

    U. Müller-Ladner

  3. Lehrstuhl für Innere Medizin mit Schwerpunkt Rheumatologie, Justus-Liebig-Universität Gießen, Gießen, Deutschland

    U. Müller-Ladner

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  1. E. Decker
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  2. U. Müller-Ladner
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Correspondence to E. Decker.

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Decker, E., Müller-Ladner, U. Rheumatoide Arthritis. Internist 54, 434–440 (2013). https://doi.org/10.1007/s00108-012-3188-1

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  • DOI: https://doi.org/10.1007/s00108-012-3188-1

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