Monitoring and Managing Cardiovascular Risk in Immune Mediated Inflammatory Diseases

Anyfanti, Panagiota; Dara, Athanasia; Angeloudi, Elena; Bekiari, Eleni; Dimitroulas, Theodoros; Kitas, George D.

doi:10.2147/jir.s276986

Cited by 11 publications

(5 citation statements)

References 127 publications

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“…At this point, based on the limited evidence available, it is only possible to suggest that interventions focused on ‘moving more’, and on breaking up sedentary time with light physical activity, might provoke beneficial changes in factors related to cardiometabolic and CVD risk in inflammatory arthritis [ 15 , 25 , 78 ]. Given that CVD is the leading cause of death among people with inflammatory arthritis [ 79 ], it might be prudent to pursue research aligned to phases 1 and 2 of the framework, with these foci. With regard to phase 3, initial research suggests that self-determination theory might offer a useful framework to inform interventions to reduce sedentary behaviour in RA [ 71 , 80 ].…”

Section: Phase 4: Interventionmentioning

confidence: 99%

The behavioural epidemiology of sedentary behaviour in inflammatory arthritis: where are we, and where do we need to go?

Fenton

O’Brien

Kitas

et al. 2022

Rheumatology Advances in Practice

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In the last decade, studies into sedentary behaviour in inflammatory arthritis have raised important questions regarding its role in this condition. Specifically, evidence is needed on whether sedentary behaviour might exacerbate adverse inflammatory arthritis outcomes, and whether reducing sedentary behaviour might offer an effective avenue for self-management in this population. Research exploring these important research questions is still very much in its infancy and lacks the direction and scientific rigour required to inform effective intervention design, delivery and evaluation. Behavioural epidemiology refers to research that aims explicitly to understand and influence health behaviour patterns to prevent disease and improve health. To this end, the Behavioural Epidemiology Framework specifies a focused approach to health behaviour research, which leads to the development of evidence-based interventions directed at specific populations. In this review, we introduce the Behavioural Epidemiology Framework in the context of research into sedentary behaviour in inflammatory arthritis and ask: where are we, and where do we need to go?

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Section: Phase 4: Interventionmentioning

confidence: 99%

The behavioural epidemiology of sedentary behaviour in inflammatory arthritis: where are we, and where do we need to go?

Fenton

O’Brien

Kitas

et al. 2022

Rheumatology Advances in Practice

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“…It has been shown over and over again that risk stratification methods aimed at the general population fall short in the assessment of patients with immune-mediated autinflammatory diseases. AI techniques might help bridge this gap and help clinicians to tailor predictive medicine to the individual patient ( 95 ).…”

Section: Artificial Intelligence: Transforming the Possibilities Of M...mentioning

confidence: 99%

Novel Surrogate Markers of Cardiovascular Risk in the Setting of Autoimmune Rheumatic Diseases: Current Data and Implications for the Future

et al. 2022

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Patients suffering from rheumatologic diseases are known to have an increased risk for cardiovascular disease (CVD). Although the pathological mechanisms behind this excess risk have been increasingly better understood, there still seems to be a general lack of consensus in early detection and treatment of endothelial dysfunction and CVD risk in patients suffering from rheumatologic diseases and in particular in those who haven't yet shown symptoms of CVD. Traditional CVD prediction scores, such as Systematic Coronary Risk Evaluation (SCORE), Framingham, or PROCAM Score have been proposed as valid assessment tools of CVD risk in the general population. However, these risk calculators developed for the general population do not factor in the effect of the inflammatory burden, as well as other factors that can increase CVD risk in patients with rheumatic diseases, such as glucocorticoid therapy, abnormal lipoprotein function, endothelial dysfunction or accelerated atherosclerosis. Thus, their sole use could lead to underestimation of CVD risk in patients with rheumatic diseases. Therefore, there is a need for new biomarkers which will allow a valid and early assessment of CVD risk. In recent years, different research groups, including ours, have examined the value of different CVD risk factors such as carotid sonography, carotid-femoral pulse wave velocity, flow-mediated arterial dilation and others in the assessment of CVD risk. Moreover, various novel CVD laboratory markers have been examined in the setting of autoimmune diseases, such as Paraoxonase activity, Endocan and Osteoprotegerin. Dyslipidemia in rheumatoid arthritis (RA) is for instance better quantified by lipoproteins and apolipoproteins than by cholesterol levels; screening as well as pre-emptive carotid sonography hold promise to identify patients earlier, when prophylaxis is more likely to be effective. The early detection of subtle changes indicating CVD in asymptomatic patients has been facilitated through improved imaging methods; the inclusion of artificial intelligence (AI) shows promising results in more recent studies. Even though the pathophysiology of coronary artery disease in patients with autoimmune rheumatic diseases has been examined in multiple studies, as we continuously gain an increased understanding of this comorbidity, particularly in subclinical cases we still seem to fail in the stratification of who really is at risk—and who is not. A the time being, a multipronged and personalized approach of screening patients for traditional CVD risk factors, integrating modern imaging and further CV diagnostic tools and optimizing treatment seems to be a solid approach. There is promising research on novel biomarkers, likewise, methods using artificial intelligence in imaging provide encouraging data indicating possibilities of risk stratification that might become gold standard in the near future. The present review concentrates on showcasing the newest findings concerning CVD risk in patients with rheumatologic diseases and aims to evaluate screening methods in order to optimize CVD risk evaluation and thus avoiding underdiagnosis and undertreatment, as well as highlighting which patient groups are most at risk.

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“…25 Artificial intelligence techniques have shown promising potential for tailoring predictive medicine to the individual patients. 26 …”

Section: Introductionmentioning

confidence: 99%

Overview of Rheumatoid Arthritis and Scientific Understanding of the Disease

Jahid,

Khan,

Rehan-Ul-Haq

et al. 2023

MJR

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Rheumatoid arthritis (RA), a chronic inflammatory autoimmune disorder, is characterised by persistent synovial inflammation, erosion of bones and cartilage, leading to joint destruction. Clinical manifestations are morning stiffness, pain in shoulder, neck and pelvic girdle, loss of mobility with fever, fatigue, malaise, loss of body weight, and development of rheumatoid nodules. Environmental and genetic factors are important contributors in its susceptibility. Association between RA and diet, cigarette smoking, hormones, alcohol, microbiota, infection, and coffee have also been reported. To diagnose patients with RA, American college of rheumatology (ACR, 2010) criteria, developed by European league against rheumatism (EULAR). Inflammation produced in RA patients is due to cell-mediated immune response. The rheumatoid synovium consists of a large number of CD 4 + T cells suggesting pathogenic nature of T cells in this disorder. B-cells may also participate in the pathogenesis by several means such as autoantibodies, by instigation of T-cells through expression of co-stimulatory molecules, by generating pro-inflammatory and anti-inflammatory cytokines and by organisation of other inflammatory cells. The conventional management of RA usually focuses over reducing pain and limiting the disability by medical therapies which include a number of classes of agents such as non-steroidal anti-inflammatory drugs (NSAIDs), non-biological and biological agents, disease-modifying anti rheumatic drugs (DMARDs), immunosuppressants, and corticosteroids. However, only proper rehabilitation can promote the objective to achieve the joint functionality and ease of motion which improves independence as well as quality of life in patient suffering from Rheumatoid Arthritis.

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Monitoring and Managing Cardiovascular Risk in Immune Mediated Inflammatory Diseases

Cited by 11 publications

References 127 publications

The behavioural epidemiology of sedentary behaviour in inflammatory arthritis: where are we, and where do we need to go?

The behavioural epidemiology of sedentary behaviour in inflammatory arthritis: where are we, and where do we need to go?

Novel Surrogate Markers of Cardiovascular Risk in the Setting of Autoimmune Rheumatic Diseases: Current Data and Implications for the Future

Overview of Rheumatoid Arthritis and Scientific Understanding of the Disease

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