Artrite reumatoide ed aumentato rischio cardiovascolare: impatto delle differenti terapie farmacologiche [Rheumatoid arthritis and increased cardiovascular risk: role of the different pharmacological therapies]

In recent years, many evidences about the correlation between cardiovascular (CV) and rheumatic diseases - among which the most important is rheumatoid arthritis (RA) - are coming out. In patients with RA, increased risk (about ve fold) has been documented. In these subjects, endothelial cell activation, in ammation and cytokines release are early altered and set the framework on which the atherosclerotic process begins. Therapies used to treat RA can in uence the CV pro le associated with RA. Infact, it has been demonstrated that Non-Steroidal Anti-In ammatory Drugs (NSAIDs) and corti- costeroids (CCS) may represent a risk factor for CV events: the rst by in uencing blood pressure val- ues, and the latter by worsening blood lipids pro le and glycemia. On the contrary, synthetic Disease Modifying Antirheumatic Drugs (sDMARDs) including the most used Methotrexate (MTX), have been shown to reduce CV damage and all-cause mortality by reducing systemic in ammation. Biologic Disease Modifying Antirheumatic Drugs (bDMARDs) in particular anti-Tumor Necrosis Factor alpha (TNFα), showed to have a therapeutic effect preventing atherosclerotic damage, reducing the risk of myocardial infarction and the overall CV risk. Therefore an early therapy with s- and b-DMARDs may represent a viable therapeutic option to manage increased CV risk associated with RA.