Thromboembolic and cardiovascular risk in rheumatoid arthritis: role of the haemostatic system

Abstract

Circumstantial evidence suggests that the innate immune system and coagulation system share a common evolutionary origin, which explains the extensive crosstalk between inflammatory cytokines and coagulation factors, with many components being important for both systems. This crosstalk has been extensively studied in sepsis, an acute state of high-grade inflammation. However, rheumatoid arthritis (RA) as well as many other autoimmune diseases can also be considered as a prothrombotic state. More and more studies show that autoimmune diseases, including RA, are a risk factor for cardiovascular disease, and also for venous thromboembolic events, such as pulmonary embolism and deep vein thrombosis. Inflammation and its effect on the haemostatic system is probably the link between these diseases. This viewpoint gives an update of the current literature on thromboembolic risk in RA, but also documents important knowledge gaps. This viewpoint will therefore help to focus on further research topics to improve diagnostic and therapeutic options which may relieve both the proinflammatory and the prothrombotic burden of autoimmune diseases.

Plasma Fibrinogen, D-dimer, and Fibrin Degradation Product as Biomarkers of Rheumatoid Arthritis

“…It has been reported that autoimmune diseases such as RA, ankylosing spondylitis, and lupus nephritis are associated with disorders of coagulation system [15][16][17]. There are studies showing that coagulation is activated in the joint of RA patients [15,18], and alterations in levels of coagulation factors have been related to vascular disease in RA [19]. Fibrinogen (FIB) is a key factor implicated in the process of blood coagulation cascade, and its deposition in the joint was recognized to be characteristic of RA and even may be responsible for the formation of pannus tissue [15].…”

Interleukin-6 inhibition and cardiovascular disease in patients with rheumatoid arthritis

“…ТЦЗ и система коагуляции. Активация каскада коагуляции является одним из этапов ССО у больных РА [101]. ИЛ-6 и α-ФНО -основные провоспалительные цитокины, которые ассоциируются с тромбоэмболическими осложнениями.…”

Possible Implication of Red Blood Cells in the Prothrombotic Risk in Early Rheumatoid Arthritis

“…This is associated with activation of ERK signaling pathway and overexpression of survivin. This possibly leads to alterations of RBC homeostasis that, together with increased ESR and inflammatory protein CRP 10 , could alter blood flow 1 …”

“…Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that can be considered as a prothrombotic state 1 . A great number of studies have investigated the possible role of reactive oxygen species (ROS) in the etiology and pathogenesis of this disease.…”