Coronary artery disease in rheumatoid arthritis: Pathogenesis, risk factors, clinical manifestations, and diagnostic implications
- Katherine P Liao, MD, MPH
Katherine P Liao, MD, MPH
- Assistant Professor
- Harvard Medical School
- Section Editor
- Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
- Section Editor — Rheumatoid Arthritis
- Emeritus Professor of Rheumatology, Imperial College London
- Visiting Professor, Oxford University
The prevalence of atherosclerotic coronary artery disease (CAD) is increased in patients with chronic inflammatory diseases such as systemic lupus erythematosus or rheumatoid arthritis (RA).
The epidemiologic evidence, possible pathogenetic mechanisms, and clinical relevance of CAD in RA will be reviewed here. The impact of CAD on the management of RA; other cardiac manifestations of RA, including pericarditis, myocarditis, atrioventricular block, valvular regurgitation, embolic events, and rheumatoid nodules; and the general clinical manifestations of RA are presented separately. (See "Coronary artery disease in rheumatoid arthritis: Implications for prevention and management" and "Overview of the systemic and nonarticular manifestations of rheumatoid arthritis", section on 'Cardiac disease' and "Rheumatoid nodules", section on 'Cardiac nodules' and "Clinical manifestations of rheumatoid arthritis".)
An increased risk of premature death is observed in patients with rheumatoid arthritis (RA). This is largely due to cardiovascular disease, particularly coronary artery disease (CAD). (See "Disease outcome and functional capacity in rheumatoid arthritis", section on 'Comorbidity and mortality'.)
The reported incidence and prevalence of CAD in patients with RA varies based upon the specific manifestations of the disease, the population evaluated, and/or the screening and diagnostic methods utilized [1-7]. A meta-analysis of 24 observational studies comprising 111,758 patients concluded that the risk of CAD mortality was 59 percent higher in patients with RA than in the general population . Risk may be increased once symptoms develop and before patients meet formal classification criteria for the diagnosis of RA [9-11].
Many of the underlying mechanisms of pathogenesis of atherosclerosis are shared in patients with and without rheumatoid arthritis (RA). Among the general population, it is increasingly clear that inflammation has a significant role in the development of coronary artery disease (CAD) and that the innate and adaptive immune systems play an important role in the initiation and progression of atherosclerosis.
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