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。在一起， 减肥和体育活动可以通过减少脂肪量来改善传统的心脏代谢健康， 骨骼肌质量和功能增益。此外，疾病相关的心血管风险将改善， 脂肪量减少和运动都能减少全身炎症。为了探索这一假设，26岁以上， 超重至肥胖的RA患者将随机接受基于传统临床 咨询或监督减肥加运动训练计划（每周3次）。减肥会 通过营养师主导的干预措施，在16周内减轻7%的体重，每周称重， 支持会议。运动训练将包括每周三次的间歇性有氧运动 再加上每周两次的抗阻训练减肥和运动训练都将受到监督， 安全和坚持。主要的心脏代谢结果是高度有效的代谢综合征z评分， 根据血压、腰围、HDL-胆固醇、甘油三酯和葡萄糖计算。RA相关 心血管风险将通过测量全身炎症、RA疾病活动度和 巨噬细胞功能-风湿和心血管疾病活动的关键细胞。干预 将使用患者报告的经验证的指标评估对自我报告结局的影响 成果计量信息系统。这项探索性临床试验将显示， 监督下的减肥和运动训练干预改善了对RA的客观评估 心血管风险、疾病活动性和患者报告整体健康改善的结果。这次调查 将建立可行性，可接受性，合规性，保真度，并产生设计更大的关键效应大小 RA干预，特别是那些比较体重减轻和身体活动量和类型。还通过 这表明通过体力活动减轻体重不仅可以改善RA相关的心血管风险， 疾病活动，以及患者报告的全球健康，这项工作应提供即时和长期的 对RA临床护理的影响。

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, 26 older, overweight to 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.