As reported by literature, rheumatoid arthritis is a rheumatic disease with an increased risk of developing cardiovascular complications. Early detection of atherosclerosis by non-invasive techniques represent a current challenge of patient management. Current EULAR guidelines recommend careful monitoring of cardiovascular risk factors by stratification of patients and strict control of rheumatic disease activity to reduce it. The classic evaluation of intima- medium thickness (IMT) was completed by quantifying the degree of inflammation of the carotid plate using positron emission tomography or the degree of coronary calcifications by calculating Agatston score using Coronary Computer Tomography. These modern investigation techniques allow identification of several subclinical stages of atherosclerosis, the interest in their early detection resulting from the fact that, in this stage, through specific measures, the cardiovascular complications can be prevented.
A symbiotic association between humans and microbes has been established over time. Disruptions in gut homeostasis have been linked to immune-mediated inflammatory diseases. Factors such as genetics, environment, diet, age, and medication play a major role in shaping the intestinal microbiome. An altered gut microbiome seems to modulate the progression and severity of inflammatory rheumatic diseases. Disruptions in the eubiotic state of the intestinal microbiome might promote intestinal and extraintestinal autoimmune and inflammatory disorders, although the mechanisms involved are not well understood. In this review, we provide a general overview of several studies concerning intestinal microbiome perturbations and their implications in rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus. Furthermore, we discuss the relationship between diet, intestinal microbiota, and inflammation.
Auto-immune rheumatic diseases are characterised by high levels of inflammation that accelerate the development of atherosclerosis, increasing the cardiovascular risk. Direct evaluation of arteries such as of intima media thickness measurement is a simple test that asesses the cerebral and cardiovascular risk. In the initial stages, an increase of the intimal media thickness can be observed. Later on, atherosclerosis (plaques), stenosis and occlusion of the arteries can be identified. Indirect evaluation of the cardiovascular risk can be performed using serological markers - fibrinogen, C reactive protein, estimated sedimentation rate, total cholesterol, low density lipoproteins and high density lipoproteins, homocysteine levels etc. The presence of certain lifestyle factors that increase the risk, such as smoking, sedentarism and associated pathologies such as obesity, diabetes, hypertension were assesed in patients with rheumatoid arthritis. The aim of the study is to prove the relationship between anti-tumor necrosis factor alpha therapy effect on the cardiovascular risk in rheumatoid arthritis patients.
More than 75 years after its accidental discovery, methotrexate remains an important treatment option for many diseases. Whether it is various hematological and non-hematological neoplasms, rheumatological, dermatological, or other conditions, methotrexate remains in scope. For rheumatoid arthritis, current clinical guidelines (EULAR, ACR) recommend methotrexate as the first therapeutic option. This article aims to highlight important moments in the history of this remarkable drug, to review the literature on its mechanisms of action and the arguments for which after more than half a century, methotrexate remains the gold standard in the treatment of rheumatoid arthritis but also an important option for treatment of psoriasis vulgaris (PV) and psoriatic arthritis (PsA).
