Cardiovascular disease and bone health in aging female rheumatic disease populations: A review

Abstract

Rheumatic diseases cover a wide spectrum of conditions, including primary and secondary degenerative joint diseases and autoimmune inflammatory rheumatic diseases. The risks of cardiovascular disease and osteoporosis and resultant fractures in aging female rheumatic disease populations, especially those with autoimmune rheumatic diseases, are increased. Changes in the immune system in aging populations need to be considered especially among patients with autoimmune rheumatic diseases. Immunosenescence is closely aligned to reduced adaptive immunity and increased non-specific innate immunity leading to chronic inflammation of inflammaging. The effective use of disease-modifying antirheumatic drugs to control autoimmune rheumatic diseases may also mitigate factors leading to cardiovascular disease and osteoporosis. Rheumatic diseases, which largely manifest as arthritis, predispose patients to premature joint degeneration and poor bone health and therefore have a higher risk of developing end-stage arthritis requiring joint arthroplasties sooner or more often than other patients without rheumatic disease.

Global, regional and national temporal trends in prevalence for musculoskeletal disorders in women of childbearing age, 1990–2019: an age-period-cohort analysis based on the Global Burden of Disease Study 2019

“…In fact, ageing has been recognised to be one of the most prominent risk factors for rheumatic degenerative joint diseases, which can be traced to the comprehensive effects of both cumulative exposure during natural history and age-related pathological changes in joint structures 36. Furthermore, the ageing of immune system called ‘immunosenescence’37 is tightly related to decreased adaptive immunity and increased non-specific innate immunity resulting in chronic low-grade sterile inflammation, therefore, participates in the progression of autoimmune inflammatory rheumatic diseases 38 39. Globally, unfavourable period effects and favourable cohort effects were observed.…”

Exosomes as a potential therapeutic approach in osteoimmunology

“…Despite the decrease in the number of B-lymphocytes, the level of immunoglobulins circulating in the blood increases, but these antibodies are characterized by lower affinity, high polyspecificity and autologous reactivity. As a result, autoimmune diseases associated with systemic inflammation such as rheumatoid arthritis, vasculitis, and systemic lupus erythematosus are more common in the elderly and correlate with osteoporosis as a consequence of increased production of proinflammatory mediators such as IL-1, IL-6, CRP, and TNF-α ( 21 ). IL-17 production also increases due to a shift in CD4+ T cell differentiation to Th17 instead of Th1 and Th2, and IL-17 is known to be able to activate osteoclasts.…”

Sociodemographic and health system factors associated with variations in hospitalization costs for rheumatic diseases in adults aged 45 years and older: A cross‐sectional study of provincial health accounts in Jiangsu Province, China

“…With the advancing age demographic in China, rheumatic diseases are increasingly positioned as threatening the quality of life of middle‐aged and elderly people in China. Furthermore, it is a risk factor for several other chronic diseases, including chronic pain, disability, 4 weakness, 5 cardiovascular disease, 6 and obesity 7 . Additionally, rheumatic diseases increase the psychological burden on patients, 8 double the prevalence of depression and anxiety disorders, 9 while also increasing the risk of sleep disorders 7 …”