Adiposity, joint and systemic inflammation: the additional risk of having a metabolic syndrome in rheumatoid arthritis

Gf Ferraccioli,E Gremese

doi:10.4414/smw.2011.13211

Abstract

Adiposity is a predisposing condition to atherosclerosis, and rheumatoid arthritis (RA) also predisposes to accelerated atherosclerosis. Adiposity is one of the key features of the metabolic syndrome (MetS) and it is well recognised that a metabolic syndrome (and fat tissue) is a major player in this complex network. Endothelial dysfunction and carotid intima-media thickness, early pre-clinical markers of atherosclerosis which are the main determinants of cardiovascular (CV) morbidity and mortality, occur early on in RA. RA patients have an incidence of CV diseases at least two times higher than the general population. MetS and RA have a low and a severe-moderate degree of inflammation in common, respectively. Adipose tissue has emerged as a dynamic organ that releases several inflammatory and immune mediators (adipokines). In addition, fat has been recognised as a producer of B cell activating factor (BAFF) and of chemerin, an inducer at the chondrocyte level of IL1β, TNFα, IL6, IL8 and MMP13, thus possibly contributing to cartilage damage. Since fat produces inflammation, to obtain a full control of the CV risk in RA, data suggest that it is therefore mandatory to have a "tight control" of both RA and MetS-related inflammation, especially if RA presents MetS as a co-morbidity.

Highlights

SummaryAdiposity is a predisposing condition to atherosclerosis, and rheumatoid arthritis (RA) predisposes to accelerated atherosclerosis
Rheumatoid arthritis (RA) pathobiology seems to share some common pathways with atherosclerosis, including endothelial dysfunction which is related to underlying chronic inflammation and presents in the early phases of the disease [1,2,3,4]
A recent, Dutch, cross-sectional study found that age- and gender-adjusted odds ratios for CV diseases derived from these cohorts were 3.1 for rheumatoid arthritis (RA) patients and 2.3 for individuals with type 2 diabetes (T2DM) with respect to healthy subjects, indicating that the CV risk in RA is comparable to diabetes, one of the most relevant CV risk factors

Summary

Adiposity is a predisposing condition to atherosclerosis, and rheumatoid arthritis (RA) predisposes to accelerated atherosclerosis. Adiposity is one of the key features of the metabolic syndrome (MetS) and it is well recognised that a metabolic syndrome (and fat tissue) is a major player in this complex network. Adipose tissue has emerged as a dynamic organ that releases several inflammatory and immune mediators (adipokines). Fat has been recognised as a producer of B cell activating factor (BAFF) and of chemerin, an inducer at the chondrocyte level of IL1β, TNFα, IL6, IL8 and MMP13, possibly contributing to cartilage damage. To obtain a full control of the CV risk in RA, data suggest that it is mandatory to have a “tight control” of both RA and MetS-related inflammation, especially if RA presents MetS as a co-morbidity

Introduction

Findings

Conclusions