Metabolic Abnormalities, Cardiovascular Disease, and Metabolic Syndrome in Adult Rheumatoid Arthritis Patients: Current Perspectives and Clinical Implications

Abstract

Rheumatoid arthritis is a prevalent worldwide disease, associated with an increased risk of multiple metabolic abnormalities that generate a higher disease burden. Objective: To gather the available evidence on the epidemiology, pathophysiology, current perspectives, clinical implications and prognosis of metabolic abnormalities in patients with rheumatoid arthritis. Methods: This is a narrative literature review. Search was conducted in PubMed, OVID, and Taylor & Francis databases, using the following MeSH terms: "Arthritis Rheumatoid", "Metabolic Diseases", and "Metabolic Syndrome". Results: This study describes the main metabolic manifestations of rheumatoid arthritis. Research has recognized that rheumatoid arthritis and metabolic abnormalities share pathophysiological mechanisms with an additive effect that increases cardiovascular risk. In that context, appropriate antirheumatic treatment can also impact on cardiovascular risk. Conclusion: There are metabolic abnormalities in rheumatoid arthritis patients that increase cardiovascular risk. Therefore, it is crucial to evaluate cardiovascular risk to provide appropriate comprehensive management to reduce morbidity and mortality in patients with this disease.

Methotrexate and cardiovascular prevention: an appraisal of the current evidence

“…131 In addition to inflammation and oxidative stress, traditional risk factors, for example, diabetes, arterial hypertension and the metabolic syndrome, have also been shown to account for the increased risk of atherosclerosis and cardiovascular disease in rheumatoid arthritis. 132,133 Methotrexate and cardiovascular risk Several observational studies have reported that treatment with methotrexate is associated with a significant reduction of cardiovascular and allcause mortality in patients with rheumatoid arthritis. For example, in a recent systematic review and meta-analysis of 15 studies, 7 longitudinal observational cohort, 6 retrospective cohort and 2 prospective cohort studies, the use of methotrexate was associated with a significant reduction in all-cause mortality (HR = 0.59, 95% CI: 0.50-0.71, p < 0.001).…”

“…131 In addition to inflammation and oxidative stress, traditional risk factors, for example, diabetes, arterial hypertension and the metabolic syndrome, have also been shown to account for the increased risk of atherosclerosis and cardiovascular disease in rheumatoid arthritis. 132,133…”

Lifestyle Factors and Their Influence on Rheumatoid Arthritis: A Narrative Review

“…In addition, there is now evidence that diets rich in anti-inflammatory components such as olive oil, nuts or fatty fish reduce cardiovascular risk [ 37 , 38 , 39 ]. Although these data were generated in non-RA samples, we assume that this finding is of major importance for patients with inflammatory arthritis, given that these patients have significantly elevated risk for major cardiovascular events [ 40 ].…”