Editorial
Endothelial Dysfunction, Carotid Intima-Media Thickness, and Accelerated Atherosclerosis in Rheumatoid Arthritis

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Endothelial Dysfunction in Rheumatoid Arthritis

Vascular endothelial injury is the primary event in atherosclerosis (11). It has been associated with endothelial dysfunction (12), which is the most important step in early atherogenesis and also contributes to the development of clinical features in the later stages of vascular disease including progression of atherosclerotic plaque (13, 14).

The endothelium modulates vascular tone by releasing a number of vasoactive substances including nitric oxide in response to mechanical stress (15).

Carotid IMT Another Surrogate Marker of Atherosclerosis in RA

Carotid IMT of the common carotid artery, determined by high-resolution B-mode ultrasonography, is a useful noninvasive anatomic structural measure of subclinical CV disease. It constitutes an excellent surrogate marker of macrovascular atherosclerotic disease. This is the most popular technique used to study the early structural changes in the arterial wall.

Case-control studies have shown that increased common carotid artery IMT determined by this technique is a good indicator of generalized

HLA-DRB1 Shared Epitope Alleles as Predictors of Atherosclerosis in RA

Complex interactions between environmental and genetic determinants in both the host immune system and the vasculature may operate to modifying the vascular risk in RA.

Genes within the major histocompatibility complex, in particular, HLA-DRB1 alleles encoding a common sequence of amino acids corresponding to residues 67 to 74 within the HLA-DRβ1 chain, called shared epitope alleles, are associated with increased susceptibility to RA (41). Shared epitope alleles have also been associated with an

How Can We Determine the CV Risk of a Patient with RA?

Since FMD constitutes a physiologic assessment of endothelial dysfunction and carotid IMT is an anatomic structural measure of subclinical atherosclerosis, it is logical to think that FMD may be more useful than carotid IMT in early stages of the disease. In contrast, carotid IMT might be considered in the assessment of CV risk of patients with longstanding RA.

However, a recent study on 40 patients presenting with definite RA within 12 months of symptom onset showed that RA patients exhibited

Acknowledgment

These studies by Dr. Gonzalez-Gay's group are supported by a grant from Fondo de Investigaciones Sanitarias PI06-0024 (Spain).

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