Weight loss and exercise to improve rheumatoid arthritis cardiovascular risk

尽管最近在药物治疗方面取得了革命性的进展，但类风湿性关节炎（RA）仍然是一个严重的疾病。 与心血管疾病和死亡率的增加有关。类风湿性关节炎心血管风险的结果， 传统风险因素和RA相关全身性炎症的组合。因此，要全面提高 RA心血管风险，努力应针对传统的危险因素和炎症。一个与假定 改善总体RA心血管风险的方法是通过减肥和体力活动。加在一起，重量 减肥和体力活动可以通过减少脂肪量和骨骼改善传统的心脏代谢健康 肌肉质量和功能增益。此外，与疾病相关的心血管风险将得到改善， 体重减轻和运动减少全身炎症。为了探索这一假设，44名老年肥胖者， RA将被随机分配到基于传统临床咨询的对照干预组或监督体重组 减肥加运动训练计划（每周3次）。减肥将通过营养师主导的干预发生 目标是在16周内减轻7%的体重，每周称重和小组支持会议。运动训练 将包括每周三次的间歇性有氧运动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依从性。主 心脏代谢结果是一个高度验证的代谢综合征z评分，从血压，腰围， 周长、HDL-胆固醇、甘油三酯和葡萄糖。RA相关心血管风险将通过以下指标进行评估： 全身性炎症、RA疾病活动和巨噬细胞功能的测量-- 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 使用患者报告结局测量信息系统（PROMIS）的经验证测量。 这项探索性的临床试验将显示是否有监督的干预与减肥和运动训练 改善对RA心血管风险、疾病活动和患者报告结果的客观评估 全面改善健康状况。该调查将确定可行性、可接受性、合规性、忠诚度， 产生对设计更大的RA干预措施至关重要的效应大小，特别是那些比较体重减轻和 体力活动的数量和类型。此外，通过证明体育活动减肥不仅 改善RA相关的心血管风险和疾病活动，而且患者报告的全球健康， 工作应提供RA临床护理的直接和持久的影响。

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.