These rheumatism are the most "sad"!

*Only for medical professionals to read for reference SSc, SLE, psoriasis.
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Because patients with chronic inflammatory diseases (CID) are at increased risk of coronary heart disease (CHD) and myocardial infarction (MI), clinically, these "sad" Diseases should also be paid attention to
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In fact, the primary prevention guidelines of the European Society of Cardiology (ESC) and the American Heart Association (AHA) have pointed out that psoriasis, rheumatoid arthritis (RA), human immunodeficiency virus (HIV) and systemic lupus erythematosus (SLE) ) CID is a risk factor for atherosclerotic cardiovascular disease (ASCVD)
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So which CID is the most "sad"? A recent study published in the journal "Frontiers in Cardiovascular Medicine" [1] gave the answer through comparison
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Figure 1 Study title 01 SLE, SSc and multiple CID double the risk of CHD.
The study found that compared with the non-CID control group, the risk of CHD in SLE patients is twice as high, and the risk of CHD in SSc patients is 2.
1 times, and the risk of CHD in multiple CID The risk of CHD is 2 times, both are significantly higher
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The risk of CHD in patients with HIV, psoriasis, RA, or inflammatory bowel disease (IBD) was not significantly higher than that of the control group
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If only MI is considered, only the risk of MI in SSc patients is 3.
6 times that of the control group, and the risk of MI in other groups does not increase significantly
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Figure 2 The risk of CHD and MI in the CID group 02 Regardless of the level of inflammation, the risk of CHD in SLE and SSc patients is increased.
Studies have found that some CIDs are closely related to the risk of CHD and MI, so whether this relationship is related to the disease Is it related to the level of inflammation? Next, the researchers explored the relationship between the level of inflammation in the CID group and the risk of CHD and MI
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The results showed that compared with the control group, regardless of the baseline C-reactive protein (CRP) level, the risk of CHD in the three groups of SLE patients was significantly increased
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However, although the risk of CHD in other CID subgroups was not significantly increased, a higher inflammatory burden (ie higher CRP or lower CD4) was associated with a higher value of CHD risk in the CID group
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Figure 3 The risk of CHD in the CID group stratified by disease severity compared with the control group, the risk of MI in all three groups of SLE patients was also significantly higher
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In addition, HIV and RA patients with high inflammatory burden surrogate markers have a significantly higher risk of MI.
HIV patients with the lowest CD4 (HR 2.
0) and RA patients with the highest CRP (HR 2.
1) have a risk of MI that are about that of the control group.
2 times
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Overall, the results of the study show that regardless of the degree of inflammation, patients with SLE and SSc have an increased risk of CHD, and patients with severe SLE have a higher risk of MI
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The risk of CHD in patients with HIV, RA, and IBD is only increased in people with higher disease severity
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Therefore, clinicians should conduct personalized assessment and treatment for patients with CHD risk based on the type and severity of CID
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03What does the guide say about these "sad" CIDs? 01 SLE Asia Pacific Rheumatism Alliance (APLAR) released this year's SLE management guidelines [2] summarized 5 disease treatment principles, one of which pointed out: the cardiovascular system and skeletal system should be regularly evaluated, and the use of drugs or non-drug methods should be recommended Improve the health of these two aspects
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In addition, the guidelines also recommend that when patients with SLE have blood, cardiovascular, and digestive tract involvement, medium to high-dose glucocorticoids (including intravenous methylprednisolone) and cyclophosphamide can be used as treatment options for severe or life-threatening conditions
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02SSc "Guidelines for the Diagnosis and Treatment of Systemic Sclerosis" [3] pointed out that 80% of SSc patients undergoing pathological examination have lamellar myocardial fibrosis
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The clinical manifestations are shortness of breath, chest tightness, palpitations, and edema
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Clinical examination may have ventricular gallop, sinus tachycardia, congestive heart failure, and occasional pericardial friction sounds
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Echocardiography shows that about half of the cases have pericardial hypertrophy or effusion, but clinical myocarditis and pericardial tamponade are rare
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03 Psoriasis "Chinese Psoriasis Diagnosis and Treatment Guidelines" [4] pointed out that in patients with psoriatic arthritis, the incidence of heart disease such as CHD and MI is increasing
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In addition to skin symptoms, patients with moderate to severe psoriasis may have other related diseases such as metabolic syndrome and cardiovascular disease
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1.
Hypertension: Psoriasis or severe psoriasis is more likely to cause severe hypertension and uncontrollable hypertension; severe psoriasis combined with hypertension can aggravate the risk of cardiovascular disease, and the use of hypertension drugs to control blood pressure can reduce the cardiovascular system The risk of the event
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For patients with psoriasis over the age of 40, the risk of hypertension is significantly increased, and annual screening is required
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2.
Cardiovascular disease: Studies have found that the incidence of CHD and MI in patients with psoriasis is significantly increased, and it is also proved that MI and cardiovascular disease risk factors (such as diabetes, hypertension, hyperlipidemia and smoking, etc.
) are related to psoriasis
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Other risk factors such as obesity, smoking, blood lipids, hypertension, age, diabetes and insulin resistance, hyperhomocysteinemia, and depression are higher than the general population or patients with other skin diseases
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3.
Treatment and mutual influence: The combined application of folic acid in patients with psoriasis treated with methotrexate can reduce the incidence of vascular diseases
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Patients using tumor necrosis factor alpha (TNF-α) inhibitors have a lower incidence of cardiovascular disease
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4.
Obesity: Obese or overweight patients with psoriasis have a significantly increased risk of metabolic syndrome or cardiovascular disease, which is also a risk factor for cardiovascular disease and metabolic syndrome
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The incidence of obesity is higher in patients with psoriasis, especially severe psoriasis
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Receiving weight loss intervention can help patients with psoriasis achieve relief
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Overweight may also interfere with the drug treatment of patients with psoriasis, such as acitretin, methotrexate, cyclosporine and some biological agents, and increase its adverse reactions
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5.
Metabolic syndrome: a group of metabolic disorders such as central obesity, hypertension, insulin resistance, and dyslipidemia syndromes.
Other cardiovascular disease risk factors usually occur concurrently with metabolic syndrome, and cardiovascular disease will appear in the future.
The risk will increase exponentially
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Studies have found that the incidence of metabolic syndrome is higher in adults with early-onset psoriasis
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04RA In recent years, more and more evidence has shown that glucocorticoids have a negative impact on the long-term prognosis of patients with RA or other rheumatism, including increased risk of infection, osteoporosis, and cardiovascular disease
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In response, the new version of the "American College of Rheumatology (ACR) RA Treatment Guidelines" [5] released this year has updated several recommendations against the use of glucocorticoid therapy
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For example: it is conditionally recommended to use traditional synthetic antirheumatic drugs (csDMARD), and not to use short-term hormones (<3 months), rather than to use csDMARD in combination with short-term hormones; it is strongly recommended to use csDMARD and not to use long-term hormones ( ≥3 months) instead of using csDMARD combined with long-term hormones
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The guidelines also raise several key clinical issues that need to be further studied, including how to optimize the treatment plan for patients with comorbidities
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It only takes five seconds! References: [1] Sinha A, Rivera AS, Chadha SA, et al.
Comparative Risk of Incident Coronary Heart Disease Across Chronic Inflammatory Diseases.
Front Cardiovasc Med.
2021;8:757738.
Published 2021 Nov 10.
doi:10.
3389/fcvm .
2021.
757738[2]Chi CM, Hamijoyo L, N Kasitanon, et al.
The Asia-Pacific League of Associations for Rheumatology consensus statements on the management of systemic lupus erythematosus[J].
The Lancet Rheumatology, 2021, 3(suppl 1) .
[3] Chinese Medical Association Rheumatology Branch.
Guidelines for the diagnosis and treatment of systemic sclerosis[J].
Chinese Journal of Rheumatology, 2011, 15(4):4.
[4]Zhang Xibao, Zhang Xuejun.
Chinese Psoriasis Interpretation of Diagnosis and Treatment Guidelines (2018 Complete Edition)[J].
Chinese Medical Information Guide, 2019, 34(22):1.
[5]Fraenkel L,Bathon JM,England BR,et al.
2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.
Arthritis Care Res(Hoboken).
2021 Jul;73(7):924-939.