Weight loss and exercise to improve rheumatoid arthritis cardiovascular risk

尽管最近在药物治疗方面有了革命性的改进，但类风湿性关节炎(RA)仍然 与心血管疾病和死亡率的增加有关。RA心血管风险由以下因素引起 传统危险因素和RA相关全身性炎症的组合。因此，要全面提高 对于RA心血管风险，应努力同时针对传统风险因素和炎症。一个假设 改善整体RA心血管风险的方法是通过减肥和体力活动。加在一起，权重 减肥和体力活动可以通过减轻脂肪质量和骨骼来改善传统的心脏代谢健康 肌肉质量和功能增加。此外，与疾病相关的心血管风险将得到改善，因为 减重和锻炼可以减少全身炎症。为了探索这一假设，44名年龄较大的肥胖者 RA将被随机分为基于传统临床咨询的对照干预或监督体重 减重加运动训练计划(每周3次)。减肥将通过营养师主导的干预进行 目标是在16周内减掉7%的体重，每周称体重，并举行团体支持会议。运动训练 包括每周三次的间歇有氧训练和每周两次的阻力训练。 减肥和运动训练都将受到监督，以最大限度地提高安全性和坚持性。初级阶段 心脏代谢结果是一个高度有效的代谢综合征z评分，根据血压、腰围计算得出 周长、高密度脂蛋白、甘油三酯和葡萄糖。与RA相关的心血管风险将通过以下方式评估 全身性炎症、类风湿性关节炎疾病活动性和巨噬细胞功能的测量--关键细胞 风湿和心血管疾病活动。将评估干预对自我报告结果的影响 使用来自患者报告结果测量信息系统(PROIS)的经过验证的措施。 这项探索性临床试验将显示，通过减肥和运动训练进行监督干预 改进对RA心血管风险、疾病活动性和患者报告结果的客观评估 健康状况总体改善。这项调查将确定可行性、接受性、合规性、忠诚度和 产生对设计更大规模的RA干预至关重要的影响大小，特别是那些比较减肥和 体力活动的数量和类型。此外，通过证明通过体育锻炼减肥不仅是 改善与RA相关的心血管风险和疾病活动，但也改善患者报告的全球健康，这 这项工作应该对类风湿关节炎的临床护理产生直接和长期的影响。

Despite recent, revolutionary improvements in pharmacologic management, rheumatoid arthritis (RA) remains associated with increased rates of cardiovascular disease and mortality. RA cardiovascular risk results from a combination of traditional risk factors and RA-related systemic inflammation. Consequently, to improve overall RA cardiovascular risk, efforts should target both traditional risk factors and inflammation. One hypothetical means of improving overall RA cardiovascular risk is through weight loss and physical activity. Together, weight loss and physical activity can improve traditional cardiometabolic health through fat mass loss and skeletal muscle quality and functional gains. Additionally, disease-related cardiovascular risk will improve as both fat mass loss and exercise reduce systemic inflammation. To explore this hypothesis, 44 older, obese persons with RA will be randomized to a control intervention based on traditional clinical counselling or to a supervised weight loss plus exercise training program (3 times per week). Weight loss will occur via a dietitian-led intervention targeting 7% weight loss over 16 weeks, with weekly weigh-ins and group support sessions. Exercise training will consist of three times per week of an interval-based aerobic program plus twice-weekly resistance training. Both weight loss and exercise training will be supervised to maximize safety and adherence. The primary cardiometabolic outcome is a highly validated metabolic syndrome z-score, calculated from blood pressure, waist circumference, HDL-cholesterol, triglycerides, and glucose. RA-related cardiovascular risk will be assessed with measures of systemic inflammation, RA disease activity, and macrophage function – key cells at the nexus of rheumatic and cardiovascular disease activity. Intervention impacts on self-reported outcomes will be assessed with validated measures from the Patient Reported Outcomes Measurement Information System (PROMIS). This exploratory clinical trial will show whether a supervised intervention with weight loss and exercise training improves objective assessments of RA cardiovascular risk, disease activity and results in patients reporting overall improved health. This investigation will establish feasibility, acceptance, compliance, fidelity, and generate effects sizes critical for designing larger RA interventions, especially those comparing weight loss and physical activity amounts and types. Also, by demonstrating that weight loss with physical activity not only improves RA-associated cardiovascular risk and disease activity, but also patient-reported global health, this work should provide immediate and long-lasting impacts on RA clinical care.