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。一起， 减肥和体育锻炼可以通过减轻脂肪质量和改善传统的心脏代谢健康 骨骼肌质量和功能获得。此外，与疾病相关的心血管风险将随着 脂肪减量和运动都可以减少全身炎症。为了探索这一假设，26岁以上的人， 超重的类风湿性关节炎肥胖者将在传统临床基础上随机进行对照干预 咨询或有监督的减肥加运动训练计划(每周3次)。减肥会让你 通过营养师领导的干预措施进行，目标是在16周内减掉7%的体重，每周称体重并分组 支持会议。运动训练将包括每周三次的间歇性有氧训练 外加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 安全性和坚持性。心脏代谢的主要结果是高度有效的代谢综合征z评分， 根据血压、腰围、高密度脂蛋白、甘油三酯和葡萄糖计算得出。RA相关 心血管风险将通过全身炎症、类风湿性关节炎活动和 巨噬细胞功能--风湿病和心血管疾病活动的关键细胞。干预 对自我报告结果的影响将通过报告的患者的有效措施进行评估 成果计量信息系统(PROMIS)。这项探索性临床试验将表明， 减重和运动训练的监督干预改善了RA的客观评估 心血管风险、疾病活动和患者报告总体健康改善的结果。这项调查 将建立可行性、接受性、合规性、保真度，并产生对设计更大规模至关重要的效果大小 RA干预，尤其是那些比较减肥和体力活动数量和类型的干预措施。此外，由 证明通过体育锻炼减肥不仅可以改善与RA相关的心血管风险，而且 疾病活动，也是患者报告的全球健康，这项工作应该提供立竿见影和持久的 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.