Información del artículo
Resumen
La artritis reumatoide y la aterosclerosis comparten mecanismos inflamatorios subyacentes similares, por lo que se sospecha que en los pacientes con artritis reumatoide existe una aterosclerosis acelerada. Este proceso explicaría la mayor incidencia de acontecimientos cardiovasculares que conducen a una morbilidad y una mortalidad mayores en pacientes sobre todo seropositivos para el factor reumatoide y otros factores de mal pronóstico. Estos hechos son independientes de otros factores de riesgo cardiovascular, por lo que conviene detectar precozmente el estado de las arterias de los pacientes con artritis reumatoide; así, se revisan las principales técnicas no invasivas, fundamentalmente ecográficas, que detectan subclínicamente la aterosclerosis. Se analizan los estudios que miden la elasticidad, la compliancia y la rigidez de las arterias mediante el análisis de la onda del pulso, la disfunción endotelial y el engrosamiento de la íntima-media de la arteria carótida común realizados en pacientes con artritis reumatoide y que abren una nueva vía de investigación para la prevención y el tratamiento de esta manifestación extraarticular de la artritis reumatoide.
Palabras clave:
Artritis reumatoide
Aterosclerosis
Técnicas no invasivas
Abstract
Rheumatoid arthritis and atherosclerosis share of a similar subjacent inflammatory mechanisms. It is suggested that an accelerated atherosclerosis is present in patients with rheumatoid arthritis. This process could explain the elevated incidence of cardiovascular events that bring to high morbidity and mortality of patients with rheumatoid arthritis, above all, seropositive patients with other additional factors of severe prognosis. These facts are independent of other cardiovascular risk factors, however, it is convenient to study as soon as possible the arteries of patients with rheumatoid arthritis. Non invasive techniques, as ultrasonographic examination, are reviewed. In addition, the studies of elasticity, compliance and stiffness of arteries by pulse wave analysis, the endothelial dysfunction and the thickness of the arterial intimate-media of the common carotid artery of patients with rheumatoid arthritis are analysed. This new tools are excellent to prevent and cure this new extraarticular manifestation of rheumatoid arthritis which remained open.
Key words:
Rheumatoid arthritis
Atherosclerosis
Non invasive techniques
El Texto completo está disponible en PDF
Bibliografía
[1.]
P. Libby, P.M. Ridker, A. Maseri.
Inflammation and atherosclerosis.
Circulation, 105 (2002), pp. 1135-1143
[2.]
V. Pasceri, E.T. Yeh.
A tale of two diseases: atherosclerosis and rheumatoid arthritis.
Circulation, 100 (1999), pp. 2124-2126
[3.]
N. Sattar, D.W. McCarey, H. Capell, I.B. McInnes.
Explaining how “gh-grade”y stemic inflammation accelerates vascular risk in rheumatoid Arthritis.
Circulation, 108 (2003), pp. 2957-2963
[4.]
S. Cobb, F. Anderson, W. Bayer.
Length of life and cause of death in rheumatoid arthritis.
N Engl J Med, 249 (1953), pp. 553-556
[5.]
S. Wållberg-Jonsson, M.L. Öhman, S. Rantapää-Dahlqvist.
Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in northern Sweden.
J Rheumatol, 24 (1997), pp. 445-451
[6.]
N.J. Goodson, N.J. Wiles, M. Lunt, et al.
Mortality in early inflammatory polyarthritis.
Arthritis Rheum, 46 (2002), pp. 2010-2019
[7.]
T. Riise, B.K. Jacobsen, J.T. Gran, et al.
Total mortality is increased in rheumatoid arthritis: A 17-year prospective study.
Clin Rheumatol, 20 (2001), pp. 123-127
[8.]
E. Lindqvist, K. Eberhardt.
Mortality in rheumatoid arthritis patients with disease onset in the 1980s.
Ann Rheum Dis, 58 (1999), pp. 11-14
[9.]
E.JA. Kroot, M.A. van Leeuwen, M.H. van Rijswijk, et al.
No increased mortality in patients with rheumatoid atrhritis: up to 10 years of follow-up from disease onset.
Ann Rheum Dis, 59 (2000), pp. 954-958
[10.]
T. Sokka, T. Mottonen, P. Hannonen.
Mortality in early “wtooth”Seated rheumatoid arthritis patients during the first 8-14 years.
Scandinavian J Rheumatol, 28 (1999), pp. 282-287
[11.]
I.D. Rincon, K. Williams, M.P. Stern, et al.
High incidence of cardiovascular events in a rheumatoid arthritis not explained by traditional cardiovascular risk factors.
Arthritis Rheum, 44 (2001), pp. 2737-2748
[12.]
D.H. Solomon, E.W. Karlson, E.B. Rimm, C.C. Cannuscio, L.A. Mandl, J.E. Manson, et al.
Cardiovascular morbidity and mortality in women diagnosed with rheumatoid artritis.
Circulation, 107 (2003), pp. 1297-1301
[13.]
S. Van Doornum, G. McColl, I.P Wicks.
Accelerated atherosclerosis: an extraarticular feature of rheumatoid arthritis?.
Arthritis Rheum, 46 (2002), pp. 862-873
[14.]
T.B. Watt Jr, C.S. Burrus.
Arterial pressure contour analysis for estimating human vascular properties.
J Appl Physiol, 40 (1976), pp. 171-176
[15.]
S.P. Glasser.
On arterial physiology, pathophysiology of vascular compliance, and cardiovascular disease.
Heart Dis, 2 (2000), pp. 375-379
[16.]
N.M. Van Popele, D.E. Grobbee, M.L. Bots, R. Asmar, J. Topouchian, R.S. Reneman, et al.
Association between arterial stiffness and atherosclerosis: the Rótterdam Study.
Stroke, 32 (2001), pp. 454-460
[17.]
S. Laurent, P. Boutouyrie, R. Asmar, I. Gautier, B. Laloux, L. Guize, et al.
Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients.
Hypertension, 37 (2001), pp. 1236-1241
[18.]
P. Boutouyrie, A.I. Tropeano, R. Asmar, I. Gautier, A. Benetos, P. Lacolley, et al.
Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study.
Hypertension, 39 (2002), pp. 10-15
[19.]
S. Van Doornum, G. McColl, A. Jenkins, D.J. Green, I.P. Wicks.
Screening for atherosclerosis in patients with rheumatoid arthritis: comparison of two in vivo tests of vascular function.
Arthritis Rheum, 48 (2003), pp. 72-80
[20.]
M. Wong, L. Toh, A. Wilson, et al.
Reduced arterial elasticity in rheumatoid arthritis and the relationship to vascular disease risk factors and inflammation.
Arthritis Rheum, 48 (2003), pp. 81-89
[21.]
S. Van Doornum, G. McColl, I.P. Wicks.
Atorvastatin reduces arterial stiffness in patients with rheumatoid arthritis.
Ann Rheum Dis, 63 (2004), pp. 1571-1575
[22.]
M.C. Corretti, T.J. Anderson, E.J. Benjamin, D. Celermajer, F. Charbonneau, M.A. Creager, et al.
Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilatation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force.
J Am Coll Cardiol, 39 (2002), pp. 257-265
[23.]
R. Joannides, W.E. Haefeli, L. Linder, V. Richard, E.H. Bakkali, C. Thuillez, et al.
Nitric oxide is responsible for flow-dependent dilatation of human peripheral conduit arteries in vivo.
Circulation, 91 (1995), pp. 1314-1319
[24.]
B. Takase, A. Uehata, T. Akima, T. Nagai, T. Nishioka, A. Hamabe, et al.
Endothelium-dependent flow-mediated vasodilatation in coronary and brachial arteries is suspected coronary artery disease.
Am J Cardiol, 82 (1998), pp. 1535-1539
[25.]
T. Neunteufl, R. Katzenschlager, A. Hassan, U. Klaar, S. Schwarzacher, D. Glogar, et al.
Systemic endothelial dysfunction is related to the extent and severity of coronary artery disease.
Atherosclerosis, 129 (1997), pp. 111-118
[26.]
R. Campuzano, J.L. Moya, A. García-Lledó, et al.
Asociación de la disfunción endotelial y el grosor mediointimal carotídeo con los factores de riesgo coronario en pacientes sin evidencia clínica de aterosclerosis.
Rev Esp Cardiol, 56 (2003), pp. 546-554
[27.]
C. González-Junatey, A. Testa, A. García-Castelo, C. García-Porrua, J. Llorca, J. Vidan, et al.
HLA-DRB1 status influences endotelial dysfunction in long-term treated patients with rheumatoid artritis.
Am J Med, 114 (2003), pp. 647-652
[28.]
G. Vaudo, S. Marchesi, R. Gerli, et al.
Endothelial dysfunction in young patients with rheumatoid arthritis and low disease activity.
Ann Rheum Dis, 63 (2004), pp. 31-35
[29.]
D. Hürlimann, A. Forster, G. Noll, F. Enseleit, R. Chenevard, O. Distler, et al.
Anti-tumor necrosis factor-alpha treatment improves endothelial function in patients with rheumatoid arthritis.
Circulation, 106 (2002), pp. 2184-2187
[30.]
C. González-Juanatey, A. Testa, A. García Castelo, et al.
Active but transiet improvement of endotelial function in rheumatoid artritis patients undergoing long-term treatment with anti-tumor necrosis factor α-antibody.
Arthritis Care Res, 51 (2004), pp. 447-450
[31.]
R. Salonen, J.T. Salonen.
Progression of carotid atherosclerosis and its determinants: a population-based ultrasonography study.
Atherosclerosis, 81 (1990), pp. 33-40
[32.]
R. Kawamori, Y. Yamasaki, H. Matsushima, H. Nishizawa, K. Nao, H. Hougaku, et al.
Prevalence of carotid atherosclerosis in diabetic patients: ultrasound high-resolution B-mode imaging on carotid arteries.
Diabetes Care, 15 (1992), pp. 1290-1294
[33.]
Y. Yamasaki, R. Kawamori, H. Matsushima, H. Nishizawa, M. Kodama, Y. Kajimoto, et al.
Atherosclerosis in carotid artery of young IDDM patients monitored by ultrasound high-resolution B-mode imaging.
Diabetes, 43 (1994), pp. 634-639
[34.]
J. Wofford, F. Kahl, G. Howard, W. McKinney, J. Toole, J.I. Crouse.
Relation of extent of extracranial carotid artery atherosclerosis as measured by B-mode ultrasound to the extent of coronary atherosclerosis.
Arterioscler Thromb, 11 (1991), pp. 1786-1794
[35.]
J.P. Lekakis, C.M. Papamichael, A.T. Cimponeriu, K.S. Stamatelopoulos, T.G. Papaioannou, J. Kanakakis, et al.
Atherosclerotic changes of extracoronary arteries are associated with the extent of coronary atherosclerosis.
Am J Cardiol, 85 (2000), pp. 949-952
[36.]
P.C. Simons, A. Algra, M.L. Bots, D.E. Grobbee, Y. Van der Graaf.
Common carotid intima-media thickness and arterial stiffness: indicators of cardiovascular risk in high-risk patients. The SMART Study (Second Manifestations of Arterial disease).
Circulation, 100 (1999), pp. 951-957
[37.]
M.L. Bots, A. Hofman, P.T. De Jong, D.E. Grobbee.
Common carotid intima-media thickness as an indicator of atherosclerosis at other sites of the carotid artery. The Rotterdam Study.
Ann Epidemiol, 6 (1996), pp. 147-153
[38.]
G. Heiss, A.R. Sharrett, R. Barnes, L.E. Chambless, M. Szklo, C. Alzola.
Carotid atherosclerosis measured by B-mode ultrasound in populations: associations with cardiovascular risk factors in the ARIC study.
Am J Epidemiol, 134 (1991), pp. 250-256
[39.]
A. Pujia, A. Gnasso, C. Irace, A. Colonna, P.L. Mattioli.
Common carotid arterial wall thickness in NIDDM subjects.
Diabetes Care, 17 (1994), pp. 1330-1336
[40.]
I. Wendelhag, O. Wiklund, J. Wikstrand.
On quantifying plaque size and intima-media thickness in carotid and femoral arteries: comments on results from a prospective ultrasound study in patients with familiar hypercholesterolemia.
Arterioscler Thromb Vasc Biol, 16 (1996), pp. 843-850
[41.]
D.K. Arnett, H.A. Tyroler, G. Burke, R. Hutchinson, G. Howard, G. Heiss, ARIC Investigators.
Hypertension and subclinical carotid artery atherosclerosis in blacks and whites. The Atherosclerosis Risk in Communities Study.
Arch Intern Med, 156 (1996), pp. 1983-1989
[42.]
S. Manzi, F. Selzer, K. Sutton-Tyrrell, S.G. Fitzgerald, J.E. Rairie, R.P. Tracy, et al.
Prevalence and risk factors of carotid plaque in women with systemic lupus erythematosus.
Arthritis Rheum, 42 (1999), pp. 51-60
[43.]
P. Pignoli, E. Tremoli, A. Poli, P. Oreste, R. Paoletti.
Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging.
Circulation, 74 (1986), pp. 1399-1406
[44.]
J.T. Salonen, R. Salonen.
Ultrasonographically assessed carotid morphology and the risk of coronary heart disease.
Arterioscler Thromb, 11 (1991), pp. 1245-1249
[45.]
N. Handa, M. Matsumoto, H. Maeda, H. Hougaku, T. Kamada.
Ischemic stroke events and carotid atherosclerosis. Results of the Osaka Follow-up Study for Ultrasonographic Assessment of Carotid Atherosclerosis (the OSACA Study).
Stroke, 26 (1995), pp. 1781-1786
[46.]
S. Wållberg-Jonsson, C. Backman, O. Johnson, K. Karp, E. Lunstrom, K.G. Sundqvist, et al.
Increased prevalence of atherosclerosis in patients with medium term rheumatoid arthritis.
J Rheumatol, 28 (2001), pp. 2597-2602
[47.]
Y.B. Park, C.W. Ahn, H.K. Choi, S.H. Lee, B.H. In, H.C. Lee, et al.
Atherosclerosis in rheumatoid arthritis: morphologic evidence obtained by carotid ultrasound.
Arthritis Rheum, 46 (2002), pp. 1714-1719
[48.]
Y. Kumeda, M. Inaba, H. Goto, M. Nagata, Y. Henmi, Y. Furumitsu, et al.
Increased thickness of the arterial intima-media detected by ultrasonography in patients with rheumatoid artritis.
Arthritis Rheum, 46 (2002), pp. 1489-1497
[49.]
J.K. Alkaabi, M. Ho, R. Levinson, et al.
Rheumatoid arthritis and macrovascular disease.
Rheumatology, 42 (2003), pp. 292-297
[50.]
C. González-Juanatey, J. Llorca, A. Testa, J. Revuelta, et al.
Increased prevalence of severe subclinical atherosclerotic findings in long-term treated rheumatoid artritis patients without clinically evident atherosclerotic disease.
Medicine, 82 (2003), pp. 407-413
[51.]
S. Wållberg-Jonsson, M.L. Öhman, S. Rantapää-Dahlqvist.
Wich factors are related to the presence of atherosclerosis in rheumatoid arthritis?.
S and J Rheumatol, 33 (2004), pp. 373-379
[52.]
I. Del Rincón, K. Williams, M.P. Stern, G.L. Freeman, D.H. O’Leary, A. Escalante.
Association between carotid atherosclerosis and markers of inflammation in rheumatoid arthritis patients and healthy subjects.
Arthritis Rheum, 48 (2003), pp. 1833-1840
[53.]
M. Nagata-Sakurai, M. Inaba, H. Goto, et al.
Inflammation and bone resoption as independent factors of accelerated arterial wal thickening in patients with rheumatoid arthritis.
Arthritis Rheum, 48 (2003), pp. 3061-3067
[54.]
I. Del Rincón, D.H. O’Leary, R.W. Haas, A. Escalante.
Effect of glucocorticoids on the arteries in rheumatoid artritis.
Arthritis Rheum, 50 (2004), pp. 3813-3822
Copyright © 2005. Sociedad Española de Reumatología