r e v b r a s r e u m a t o l . 2016;56(2):93–94
w w w . r e u m a t o l o g i a . c o m . b r
REVISTA
BRASILEIRA
DE
REUMATOLOGIA
Editorial
Rheumatoid
arthritis
and
metabolic
syndrome
A
artrite
reumatoide
e
a
síndrome
metabólica
Scientific research on rheumatoid arthritis (RA) led to the draftingofrecommendationsonearlydiagnosisofarticular manifestations,appropriatemeasurementsofinflammatory activityandbonedamage,andtarget-basedtreatment,which wereconsolidatedinsimilarguidelinesfromvarious organiza-tionssuchastheSociedadeBrasileiradeReumatologia(SBR), theAmericanCollegeofRheumatology(ACR)andthe Euro-peanLeagueAgainstRheumatism(EULAR).1–4Totheextent that the treatment strategies of joint manifestations have expanded interms ofoptions and effectiveness, a greater concern has arisen about associated diseases, particularly cardiovasculardisease(CVD),whichbecamethemain respon-sibleforthedecreaseofsurvivalinthispopulation,despite significantadvancesindrugtherapy.5–7
Currently,anearlierinvestigationandmonitoringof tradi-tionalriskfactorsforCVDisrecommended,sinceitspresence isassociatedwithanincreasedclinicalactivityofRA,witha worseprognosis,andwithdoublingofCVDrisk.8–13
The chronic inflammatory state, coupled with limited mobility,asedentarylifestyleandtheuseofNonsteroidal anti-inflammatorydrugs(NSAIDs)andcorticosteroids,determines theactivationofseveralharmfulmechanismsforcirculation andalsoincreasesthepredispositiontometabolicsyndrome (MS).7,8,11,14
RAandMS sharepathogenic mechanisms, forexample, anincreaseinfreeradicals,adeficiencyofantioxidant sys-tems,anincreaseinpro-inflammatorycytokines,endothelial injury,andtheformationand destabilizationof atheroscle-roticplaques.8,9,15
TheconceptofMSaroseinthe1980s,encompassingcentral obesity, dyslipidemia, systemic hypertension and hyper-glycemia/insulinresistanceas elements thatare enhanced andthat,together,offerahigherriskofCVDthanthesumof individualfactors.Theliteraturehasevolvedwiththestudy ofMSindifferentpopulations,untilthepropositionofunified criteriain2009.16,17
Althoughthe identificationofMSinpatientswithRAis veryvariable,dependingonthepopulationsstudiedandthe classificationcriteriaused,itsprevalencehasincreasedand
determinesanadditionalriskofCVD.5,15,18Abetter knowl-edgeoftheprevalenceofMSanditsassociationsindifferent groupsofpatientsresultsinsubsidiestoimprovepreventive strategies.
In this issue,Oliveira et al. evaluatedthe occurrenceof MSinpatientswithRAfollowedinauniversityhospitalin northeasternBrazil.Inthissample,withlargefemale predom-inance,morethanhalfofthepatientsfulfilleddifferentMS criteria.Inadditiontoobesity,presentinalmostallpatients withMS,therewasanassociationwithotherriskfactors,such asageandsmoking.19Thesefindingspointtoahighriskof CVDandincreasedmortality.
Thescientificcommunitystilldiscusswhetherthe assess-mentforriskofCVDshouldbecarriedoutbyinstrumentsused inthegeneralpopulation,orbytoolsadaptedforRA,toenable amorereliableriskassessment,inordertoreducemorbidity andmortality.20,21
Withthisgoal,deCamposetal.testedatoolforprediction ofcardiovascularevents,modifiedforuseinpatientswithRA –themSCOREindex.Thestudyevaluated100femalesubjects withRAversuscontrolswithoutthedisease;itwasobserved thattherewasnodifferencebetweengroupswithrespectto theresultsoftheoriginalSCOREindex.However,withtheuse ofmSCOREversion,whichincludesfactorsspecifictothe dis-ease,a3-foldincreaseinthenumberofsubjectsclassifiedas ofhighriskwasfound,thusbecomingcleartheincreasedrisk oftheoccurrenceofa10-yearfatalcardiovasculareventin patientswithRA.22
Thisstudyemphasizesthefactthat,duringasystematic evaluationofpatientswithRA,anevaluationof cardiovascu-larriskmustalsobecarriedout.Moreover,thisassessment should be performed with valid instruments, allowing the identificationoftheriskofCVDandpointingtotherapeutic targets,inordertoperformearlierandmoreefficient inter-ventions.
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rev bras reumatol.2016;56(2):93–94Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
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LS,BertoloMB,etal.ConsensodaSociedadeBrasileirade
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MarcosRenatodeAssisa,b,∗,PatríciaAmandaSerafima aFaculdadedeMedicinadeMarília(Famema),Marília,SP,Brazil
bEditor-in-Chief,RevistaBrasileiradeReumatologia,Brazil
∗Correspondingauthor.
E-mail:[email protected](M.R.Assis).
http://dx.doi.org/10.1016/j.rbre.2016.02.015
