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Ревматоидный артрит: влияние воспаления и противовоспалительной терапии на кардиоваскулярные факторы риска

https://doi.org/10.21518/2079-701X-2020-11-32-44

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Аннотация

Ревматоидный артрит является частым и одним из наиболее тяжелых иммуновоспалительных заболеваний человека, что определяет большое медицинское и социально-экономическое значение этой патологии. Одной из приоритетных проблем современной кардиоревматологии является повышенный риск сердечно-сосудистых осложнений при ревматоидном артрите. У пациентов с ревматоидным артритом выражены традиционные кардиоваскулярные факторы риска сердечно-сосудистых заболеваний (метаболический синдром, ожирение, дислипидемия, артериальная гипертензия, инсулинорезистентность, сахарный диабет, курение и гиподинамия) и генетическая предрасположенность. Определенное влияние оказывают и их специфические особенности: «липидный парадокс» и «парадокс ожирения».
Однако ведущую роль в заболеваемости и смертности от сердечно-сосудистых заболеваний при ревматоидном артрите занимает хроническое воспаление как ключевой фактор развития прогрессирования атеросклероза и эндотелиальной дисфункции. В представленном обзоре рассмотрены влияние хронического воспаления и его медиаторов на традиционные кардиоваскулярные факторы риска и его самостоятельное значение в развитии ССЗ.
Определенное влияние на кардиоваскулярные факторы риска у пациентов с РА оказывает и лекарственная терапия (нестероидные противовоспалительные препараты, глюкокортикостероиды, базисные противовоспалительные препараты, генно-инженерные биологические препараты) основного заболевания. Проведенный обзор исследований по этой проблеме позволяет предполагать позитивное влияние фармакологического вмешательства при ревматоидном артрите на кардиоваскулярные факторы риска, их снижение до уровня, сопоставимого с популяциями пациентов, не страдающих ревматоидным артритом. Взаимодействие ревматологов, кардиологов и врачей первого контакта (терапевта и врача общей практики) в изучении механизмов развития атеросклероза у больных ревматоидным артритом позволит в реальной клинической практике разработать адекватные методы своевременной диагностики и профилактики сердечно-сосудистых заболеваний у пациентов ревматоидным артритом.

Об авторах

Д. И. Трухан
Омский государственный медицинский университет
Россия

Трухан Дмитрий Иванович, д.м.н., доцент, профессор кафедры поликлинической терапии и внутренних болезней

644043, Омск, ул. Ленина, д. 12



Д. С. Иванова
Омский государственный медицинский университет
Россия

Иванова Дарья Сергеевна, к.м.н., доцент кафедры поликлинической терапии и внутренних болезней

644043, Омск, ул. Ленина, д. 12



К. Д. Белус
Омский государственный медицинский университет
Россия

Белус Кристина Дмитриевна, студентка 6-го курса лечебного факультета

644043, Омск, ул. Ленина, д. 12



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Для цитирования:


Трухан Д.И., Иванова Д.С., Белус К.Д. Ревматоидный артрит: влияние воспаления и противовоспалительной терапии на кардиоваскулярные факторы риска. Медицинский Совет. 2020;(11):32-44. https://doi.org/10.21518/2079-701X-2020-11-32-44

For citation:


Trukhan D.I., Ivanova D.S., Belus K.D. Rheumatoid arthritis: influence of inflammation and anti-inflammatory therapy on cardiovascular risk factors. Meditsinskiy sovet = Medical Council. 2020;(11):32-44. (In Russ.) https://doi.org/10.21518/2079-701X-2020-11-32-44

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