Important Considerations for Examining Endothelial Dysfunction in Rheumatoid Arthritis

Abstract

Rheumatoid arthritis (RA) is the most common inflammatory autoimmune disease with patients presenting with an increased risk for cardiovascular disease (CVD).1 It has been hypothesised that interactions between RA disease-related inflammation and classical cardiovascular disease risk factors may accelerate atherosclerosis.2 Examination of cardiovascular risk is typically performed using non-invasive assessments of vascular function and structure in the peripheral microvessels and the large vessels (Figure 1).3 These assessments correlate well Figure 1: Non-invasive assessments can be utilised in the carotid artery to provide information about intimal thickening as well as plaque stability. Assessments in the microcirculation and large vessels indicate the functional response of the endothelium to physiological and pharmacological stimulation. The majority of studies in rheumatoid arthritis report that classical CVD risk factors and inflammation interact with each other to adversely impact on the vasculature.(Figure Presented) with invasive assessments in the coronary circulation,3 and can predict worse cardiovascular outcomes in the general population.4 In contrast, there are limited studies examining the predictive value of vascular assessments on adverse cardiovascular outcomes in RA, and several other issues need to be considered when incorporating such assessments in future research. The present editorial attempts to outline these issues and explain how they might be addressed in future research studies