Alexandru Caraba

By Alexandru Caraba, Stela Iurciuc and Mircea Iurciuc

Rheumatoid arthritis (RA) represents the one of the most common inflammatory rheumatic diseases, which generates disability and significantly reduces the quality of life. RA can affect the vascular system, in addition to joint involvement. Vascular involvement increases the morbidity and mortality among these patients. Macrovascular disease, related to accelerated atherosclerosis, has a high prevalence among RA patients, in the form of carotid artery disease, ischemic heart disease, and peripheral arterial obstructive disease. Microvascular disease, studied in recent years by means of nailfold capillaroscopy, is present even in the early stage of RA evolution. Rheumatoid vasculitis can occur in severe forms of RA.

Part of the book: Rheumatoid Arthritis

By Alexandru Caraba, Flavia Corina Babalic, Andreea Munteanu and Otilia Tomulescu

Rheumatoid arthritis (RA), one of the most common inflammatory rheumatic diseases. It is defined as a chronic destructive and deforming arthropathy; it also finds its expression through systemic manifestations. RA has an undulating evolution, with remissions and relapses. Atherosclerotic cardiovascular disease represents one of the most common extra-articular manifestations of RA. It is known that the cardiovascular (CV) morbidity and mortality represent one of the leading causes of reduced life expectancy in RA. Patients with RA develop a premature and accelerated atherosclerosis, explaining the high incidence and prevalence of angina, myocardial infarction, congestive heart failure, stroke, peripheral artery disease, and the need for revascularization. Traditional risk factors (arterial hypertension, obesity, smoking, dyslipidemia, insulin resistance and metabolic syndrome, diabetes mellitus, male gender, physical inactivity) interplay with RA-related risk factors, generating endothelial dysfunction, arterial stiffness, carotid plaque, and atherosclerosis. Traditional cardiovascular risk factors alone cannot explain the increased incidence of premature and accelerated atherogenesis. Chronic inflammation, hyperhomocysteinemia, and hypercoagulation act as novel cardiovascular risk factors. Rheumatoid inflammation exerts direct effects on vessels, or by means of altered traditional risk factors. Antirheumatic drugs may promote atherogenesis or by reducing systemic inflammation may decrease cardiovascular risk. EULAR recommendations require annual cardiovascular risk assessment.

Part of the book: Rheumatoid Arthritis