Alberto Lo Gullo
Giuseppe Mandraffino- 1Unit of Rheumatology, Department of Medicine, ARNAS Garibaldi Hospital, Catania, Italy
- 2Internal Medicine Unit, Department of Clinical and Experimental Medicine, Lipid Center, University of Messina, Messina, Italy
Editorial on the Research Topic
Chronic rheumatic inflammatory conditions and cardiovascular health
Patients with chronic inflammatory rheumatic diseases (IRD), such as systemic lupus erythematosus (SLE), chronic arthritis and vasculitis, have a higher risk of developing premature cardiovascular disease (CVD) (1, 2). The multifactorial characteristic of this condition is thought to result from an interaction of inflammation, metabolic factors, therapy- and disease-related factor. Standardized mortality ratios in patients with IRD are higher than those in the general population (3); this increased and commonly premature mortality is mainly due to cardiovascular events (CV). Interestingly, this increased risk of CVD in rheumatoid arthritis (RA) is comparable to that observed in type 2 diabetes mellitus (4). Dampening disease activity has been associated with reduction in the CV mortality of patients with IRD; furthermore treatment with anti TNF or DMARDs seem to reduce CV events (5). European League Against Rheumatism's (EULAR) evidence-based recommendations for CV risk management in patients with RA and other forms of IRD strongly support the use of algorithms to stratify the CV risk of patients with inflammatory arthritis. Briefly, to avoid the underestimation of CV risk, the EULAR task force recommends a 1.5 multiplication factor in patients with RA who meet two of the three following criteria: disease duration longer than 10 years, presence of rheumatoid factor or anti-CCP antibodies, and extra-articular manifestations (6). Taking together these observations, with this special issue the impact on cardiovascular health was assessed in the management of patients with several rheumatic conditions including chronic arthritis, connective tissue disease and vasculitis.
A systematic review on arterial stiffness in vasculitis was conducted, particularly focusing on ANCA vasculitis, Behcet disease and Takayasu Arteritis; vascular properties impairment, as measured by Pulse wave velocity, is reported in most subtypes of vasculitis, underlining the importance of an effective—and early—treatment of conventional CV risk factors, and calling for additional investigation on further ways to mitigate the risk excess (Lo Gullo et al.).
Skoog et al. reported that the examination—through an extended ultrasound protocol—of brachiocephalic and common carotid arteries can provide a very high diagnostic sensitivity in patients with suspected giant cell arteritis without affecting the specificity when temporal and axillary findings are indecisive. Kuret et al. investigated some markers potentially helpful in predicting giant cell arteritis relapses suggesting that IL-23 might be a promising biomarker of uncontrolled and active disease and could give early indication of upcoming relapses.
An update about cardiovascular risk in arthritis was also provided. Argnani et al. in a big Italian study reported that RA patients had higher incidence of atrial fibrillation (incidence rate ratio, IRR 1.28), heart failure (IRR 1.53), stroke (IRR 1.19), and myocardial infarction compared to controls . On the other hand, as reported by Schirmer, patients with spondyloarthritis, psoriatic arthritis and rheumatoid arthritis have a prevalence of CVD that is 8.7, 12.8, and 18.7% respectively (Yagensky and Schirmer). Degboè et al. reported a higher prevalence of cardiovascular risk factors (CVRs), as well as a higher prevalence of major adverse cardiovascular events in PsA compared to the general population. The CVR is higher in the PsA population than in the controls either using SCORE and QRISK2 equations or using SCORE- PsA and QRISK2-PsA equations. Hupin et al. investigated the autonomic function in RA, and in particular the parasympathetic tone, using the heart rate recovery (HRR), which improved after 1 and 2 year by guided physical activity. As regards physical activity, Garcia et al. describes the beneficial effect of personalized training program to improve aerobic activity and glycated hemoglobin in Sjogren Syndrome. Svensson et al. found impaired microcirculation in systemic lupus erythematosus as reflected by peak oxygen saturation even in the younger ages, and higher Augmentation index as compared to controls. Young people with childhood-onset rheumatic disease is known to have increased risk of CVD and Ciurtin et al. in a review describe some potential ways to improve cardiovascular safety in this population; Mondal et al., instead, describe different aspects of cardiac dysfunction in Juvenile dermatomyositis. As regards therapeutic and drug-related issues, the effects of ketogenic diet on CV outcomes in arthritis are reviewed by Ciaffi et al., reporting a favorable effect specially in RA. Soòs et al. analyzed a possible effect of anti TNF on CV system; they found that anti-TNF treatment may increase ACE and ACE2 in the sera of RA and Ankylosing spondylitis patients and may be associated with disease duration, markers of inflammation and vascular pathophysiology. Toussirot et al. describe the CV risk in spondyloarthritis with highlights on the use of bDMARDs (TNF and probably IL-17i) and specific treatment strategies, as favorable impact on CV risk and disease prognosis.
Sonographic crystal deposits and subclinical inflammation were observed in a study performed by Calabuig et al. in patients with intercritical gout; tophi and a positive Power Doppler signal were linked to carotid atherosclerosis, while the association between hyperuricemia/gout and an increased CVD risk was described by Zhu et al. in a big cohort of patients with long follow up. On the other hand, in a meta-analysis (Zhang et al.) suggests that neither allopurinol nor febuxostat significantly modify—increasing or reducing—the risk of major adverse cardiovascular events in hyperuricemic patients with or without gout.
This special issue aimed to provide an up-to-date state of the art of this constantly evolving picture.
Author contributions
Both authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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References
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2. Lo Gullo A, Rodriguez-Carrio J, Gallizzi R, Imbalzano E, Squadrito G, Mandraffino G. Speckle tracking echocardiography as a new diagnostic tool for an assessment of cardiovascular disease in rheumatic patients. Prog Cardiovasc Dis. (2020) 63:327–40. doi: 10.1016/j.pcad.2020.03.005
3. Dadoniene J, Charukevic G, Jasionyte G, Staskuviene K, Miltiniene D. Mortality in inflammatory Rheumatic diseases: lithuanian national registry data and systematic review. Int J Environ Res Public Health. (2021) 18:12338. doi: 10.3390/ijerph182312338
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5. Dixon WG, Symmons DP. What effects might anti-TNFalpha treatment be expected to have on cardiovascular morbidity and mortality in rheumatoid arthritis? A review of the role of TNFalpha in cardiovascular pathophysiology. Ann Rheum Dis. (2007) 66:1132–6. doi: 10.1136/ard.2006.063867
6. Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJ, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. (2017) 76:17–28. doi: 10.1136/annrheumdis-2016-209775
Keywords: rheumatic, inflammatory conditions and cardiovascular health, rheumatic and musculoskeletal disease, cardiovascular diseases, vasculitis, Pulse wave velocity (PWV), arterial stiffness
Citation: Lo Gullo A and Mandraffino G (2022) Editorial: Chronic rheumatic inflammatory conditions and cardiovascular health. Front. Med. 9:953756. doi: 10.3389/fmed.2022.953756
Received: 26 May 2022; Accepted: 19 July 2022;
Published: 16 August 2022.
Edited and reviewed by: João Eurico Fonseca, University of Lisbon, Portugal
Copyright © 2022 Lo Gullo and Mandraffino. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Alberto Lo Gullo, YWxiZXJ0b2xvZ3VsbG8mI3gwMDA0MDt2aXJnaWxpby5pdA==