Aktuelle Rheumatologie 2013; 38(03): 184-188
DOI: 10.1055/s-0032-1349081
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Therapie rheumatologischer Erkrankungen und Herz

Treatment of Rheumatic Diseases and the Heart
R. Fischer-Betz
1   Poliklinik für Rheumatologie, Heinrich Heine Universität Düsseldorf
,
M. Schneider
1   Poliklinik für Rheumatologie, Heinrich Heine Universität Düsseldorf
› Author Affiliations
Further Information

Publication History

Publication Date:
04 July 2013 (online)

Zusammenfassung

Die rheumatoide Arthritis (RA) ist mit einer erhöhten Mortalität assoziiert, die v. a. auf dem erhöhten kardiovaskulären Risiko basiert. Das Risiko für einen Herzinfarkt ist bei der rheumatoiden Arthritis verdoppelt. Neben den traditionellen Risikofaktoren hat eine chronische systemische Entzündung bedeutenden Einfluss auf die Entstehung der Arteriosklerose. Eine effektive Krankheitskontrolle mit Basistherapeutika („disease modifying drugs“, DMARDs) reduziert nachweislich das kardiovaskuläre Risiko bei RA-Patienten; nicht steroidale Antirheumatika (NSAR) und Glukokortikoide sind vermutlich mit einem erhöhten Risiko assoziiert. EULAR-Empfehlungen zum Management des kardiovaskulären Risikos bei Patienten mit RA wurden etabliert. Der Artikel ist zuerst erschienen in „Aktuel Kardiol 2013; 2: 24–28“.

Abstract

Rheumatoid arthritis (RA) is still associated with an increased mortality mainly due to an increase in cardiovascular risk. Studies found relative risk ratios of 2 for myocardial infarction in RA. ­Beyond the traditional CV risk factors, chronic systemic inflammation has been shown to be a crucial factor in atherosclerosis development. Control of disease activity with disease-modifying drugs (DMARDs) was shown to reduce cardiovascular risk in RA patients. Use of non-steroidal antirheumatic drugs (NSAIDs) and glucocorticoids might be associated with an increased risk. The EULAR recommendations for cardiovascular risk management in patients with rheumatoid arthritis have been established. This article was primarily published in “Aktuel Kardiol 2013; 2: 24–28”.

 
  • Literatur

  • 1 van Halm VP, Peters MJ, Voskuyl AE et al. Rheumatoid arthritis versus diabetes as a risk factor for cardiovascular disease: a cross-sectional study, the CARRE Investigation. Ann Rheum Dis 2009; 68: 1395-1400
  • 2 Solomon DH, Kremer J, Curtis JR et al. Explaining the cardiovascular risk associated with rheumatoid arthritis: traditional risk factors versus markers of rheumatoid arthritis severity. Ann Rheum Dis 2010; 69: 1920-1925
  • 3 Holmqvist ME, Wedren S, Jacobsson LT et al. Rapid increase in myocardial infarction risk following diagnosis of rheumatoid arthritis amongst patients diagnosed between 1995 and 2006. J Intern Med 2010; 268: 578-585
  • 4 Fischer-Betz R, Halle M, Schneider M. Inflammation-related cardiovascular morbidity: Pathophysiology and therapy. Z Rheumatol 2010; 69: 680-684 , 686–688
  • 5 John H, Kitas G. Inflammatory arthritis as a novel risk factor for cardio­vascular disease. Eur J Intern Med 2012; 23: 575-579
  • 6 Krüger K, Wollenhaupt J, Albrecht K et al. German 2012 guidelines for the sequential medical treatment of rheumatoid arthritis: Adapted EULAR recommendations and updated treatment algorithm. Z Rheumatol 2012; 71: 592-603
  • 7 Combe B, Swergold G, McLay J et al. Cardiovascular safety and gas­trointestinal tolerability of etoricoxib vs. diclofenac in a randomized controlled clinical trial (The MEDAL study). Rheumatology (Oxford) 2009; 48: 425-432
  • 8 Goodson NJ, Brookhart AM, Symmons DP et al. Non-steroidal anti-inflammatory drug use does not appear to be associated with increased cardiovascular mortality in patients with inflammatory polyarthritis: results from a primary care based inception cohort of patients. Ann Rheum Dis 2009; 68: 367-372
  • 9 Trelle S, Reichenbach S, Wandel S et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ 2011; 342: c7086
  • 10 Greenberg JD, Kremer JM, Curtis JR et al. CORRONA Investigators. Tumour necrosis factor antagonist use and associated risk reduction of cardiovascular events among patients with rheumatoid arthritis. Ann Rheum Dis 2011; 70: 576-582
  • 11 Maradit-Kremers H, Nicola PJ, Crowson CS et al. Cardiovascular death in rheumatoid arthritis: a population-based study. Arthritis Rheum 2005; 52: 722-732
  • 12 Westlake SL, Colebatch AN, Baird J et al. The effect of methotrexate on cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review. Rheumatology (Oxford) 2010; 49: 295-307
  • 13 Barnabe C, Martin BJ, Ghali WA. Systematic review and meta-analysis: anti-tumor necrosis factor α therapy and cardiovascular events in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2011; 63: 522-529
  • 14 Peters MJ, Symmons DP, McCarey D et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 2010; 69: 325-331