Mechanistic insights into the link between inflammation and cardiovascular disease: rheumatoid arthritis as a human model of inflammation.
Mechanistic insights into the link between inflammation and cardiovascular disease: rheumatoid arthritis as a human model of inflammation.
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对炎症与心血管疾病之间联系的机制见解：类风湿性关节炎作为人类炎症模型。
DOI：
10.1161/circimaging.114.002235
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Solomon,DanielH
中科院分区：
文献类型：
--
作者：
Liao,KatherineP;Solomon,DanielH
576 Circ心血管成像2014年7月，使用anakinra和相同的随机、安慰剂对照交叉设计。他们观察到，与安慰剂相比，服用阿那白后血管和左室功能均有改善。纳入RA合并CAD的患者在本研究中提供了可能与CAD患者更相关的额外信息。这项研究提出了几个问题。首先，作者强调了CAD组和非CAD组基线时CRP和IL-1β水平的差异。合并CAD的RA患者CRP和RA疾病活动性水平与未合并CAD的RA患者相似，但两组之间IL-1β的差异有统计学意义（3.8 vs 0.35 pg/mL）。RA疾病活动度评分（包括CRP）与RA患者IL-1β水平高度相关。由于两组的疾病活动度评分相似，无论CAD状态如何，我们都不会期望IL-1β水平有显著差异。其次，研究人员进行了几项生理和生物标志物测量。尽管作者报告了显著性水平的修正，以解释多重比较，但在大多数情况下，他们保持P< 0.05的截止值。精确的P值也没有报告，让读者怀疑是否有任何重要的关联是偶然的。最后，结果测量是在3小时后进行的，在长期研究中了解这些反应的持久性是很有趣的。在本文的临床展望部分，作者指出，阿那金可能成为RA和CAD患者的治疗选择。因为阿那金在临床上很少用于类风湿性关节炎，这是一个大胆的声明。与其他抗细胞因子DMARDs相比，阿那金对RA关节疼痛和损伤的控制效果较差。因此，anakinra在2012年美国风湿病学会RA治疗指南中没有被讨论。此外，本研究中的患者可能不能代表典型的类风湿关节炎人群，限制了这些研究结果的普遍性。CAD组和非CAD组的平均基线疾病活动度评分均为中至高，表明患者对当前RA治疗方案的反应不足。对于这些患者，2012年美国风湿病学会和2013年欧洲抗风湿病联盟治疗指南将推荐升级治疗，例如在不久的将来启动抗细胞因子DMARD。在目前的实践中，大多数患者将开始使用肿瘤坏死因子抑制剂作为下一步，数据表明，这可能会带来与IL-1抑制相似的心血管益处。8、17
576 Circ Cardiovasc Imaging July 2014 using anakinra and the same randomized, placebo-controlled crossover design. They observed improvements in both vascular and LV function after anakinra administration compared with placebo. The inclusion of RA patients with CAD in this study provides additional information potentially more relevant to patients with CAD.This study raises several questions. First, the authors highlight a difference in CRP and IL-1β levels at baseline between the CAD and non-CAD groups. The RA patients with CAD had similar levels of CRP and RA disease activity to those without, but the difference between IL-1β between the 2 groups was significant (3.8 versus 0.35 pg/mL). The RA disease activity score (which includes CRP) is highly correlated with IL-1β levels in RA. 14 Because the disease activity scores were similar in both groups, we would not expect a significant difference in the IL-1β levels, regardless of the CAD status. Second, the investigators conducted several physiological and biomarker measurements. Although the authors report correction for the level of significance to account for multiple comparisons, in most instances they maintained a P< 0.05 cutoff. Precise P values were also not reported, leaving the readers to wonder whether any of the significant associations were because of chance. Finally, the outcome measures were conducted after 3 hours, and it would be interesting to know the durability of these responses in a long-term study. In the Clinical Perspective segment of this article, the authors state that anakinra may become the treatment of choice for patients with RA and CAD. Because anakinra is seldom used clinically for RA, this is a bold statement. Anakinra has less efficacy in controlling joint pain and damage in RA than other anti-cytokine DMARDs. 15 As a result, anakinra was not discussed in the 2012 American College of Rheumatology RA treatment guidelines. 16 Furthermore, the patients in this study may not be representative of a typical RA population, limiting the generalizability of these findings. The mean baseline disease activity score of both the CAD and non-CAD groups was moderate to high, suggesting that the patients had an inadequate response to their current RA treatment regimen. For these patients, the 2012 American College of Rheumatology and the 2013 European League Against Rheumatism treatment guidelines would recommend escalation of therapy such as initiating an anti-cytokine DMARD in the near future. In current practice, the majority of patients would start a tumor necrosis factor inhibitor as the next step, which data suggest may confer similar cardiovascular benefits as IL-1 inhibition. 8, 17
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影响因子：
39.3
作者：
Recio-Mayoral, Alejandro;Mason, Justin C.;Camici, Paolo G.
通讯作者：
Camici, Paolo G.
影响因子：
37.8
作者：
Ikonomidis, Ignatios;Lekakis, John P.;Kremastinos, Dimitrios T.
通讯作者：
Kremastinos, Dimitrios T.
影响因子：
2.8
作者：
Micha, Renata;Imamura, Fumiaki;von Ballmoos, Moritz Wyler;Solomon, Daniel H.;Hernan, Miguel A.;Ridker, Paul M.;Mozaffarian, Dariush
通讯作者：
Mozaffarian, Dariush
类风湿关节炎中血浆白细胞介素 1 水平与疾病活动性的相关性
DOI：
--
发表时间：
1988
期刊：
The Lancet
影响因子：
--
作者：
J. Eastgate;N. Wood;F. Giovine;J. Symons;F. Grinlinton;G. Duff
通讯作者：
G. Duff