关闭死亡率差距：Ra和心脏病
它被称为mortality gap. And none of us like to think about it.
RA人民的平均预期寿命比一般人群少10年。RA是一种影响不仅影响我们的关节的全身疾病，还影响我们的内部器官。存在死亡率，因为RA的全身炎症导致心脏病发作和中风的发病率较高。
But there's good news. A few weeks ago at the 2012 meeting of the European League Against Rheumatism (EULAR) in Berlin, researchers发表了一篇论文显示一个戏剧性的减少heart attacks in people taking anti-TNF medication]，如垃圾，鬣狗和善意。
以前有一些证据表明这些药物减少了心血管事件的风险，但这项新的研究随着时间的推移，超过10万人的抗TNF药物进展。结果表明，有人需要抗TNF药物，患心脏病的风险越低。在一年后的抗TNF药物后，风险降低了24％，经过两年的42％，三年后与接受更多常规DMARD的人，如甲氨蝶呤和其他非生物学。
进行该研究的研究员迈克尔T. Nurmohamohamed博士在接受采访中表示，“似乎在RA的患者中，动脉粥样硬化斑块破裂之前......我们知道炎症在该过程中非常重要。当你对待时可能是这样患有抗TNF药物或其他抗炎的患者，减少斑块的炎症含量。因此斑块后来破裂。这可能是抗TNF药物降低心肌梗塞的方式。“需要进一步的研究来阐明抗TNF药物在减少心血管事件中的作用。
这是否意味着您需要急于向您的风湿病学者赶紧，并坚持用抗TNF药物治疗？Nurmohamed博士表示证据尚未支持此类决定。然而，他强调的是，“文献确实表明有效的炎症抑制对于RA患者至关重要，如果这在合理的时间框架内没有高剂量甲氨蝶呤或另一个DMARD，则用生物学，抗应考虑TNF药物。“
This is further support for the treat-to-target or tight control model in which the effect of RA treatment is assessed frequently and, if judged to not have sufficient impact, adapted to ensure suppression of active disease. The goal is to treat to remission or low disease activity. Dr. Nurmohamed says the "take-home message is that disease activity should be reduced a much as possible, first by DMARDS. If that is not enough, biologics should be considered."
Managing the Risk
Living with RA includes keeping your eye on a number of issues. Until recently, there has been very little focus on the cardiovascular aspect of RA. Rheumatologists specialize in controlling inflammation and tend to focus primarily on your joints. Therefore, they may not talk to you about the increased risk of heart disease. However, EULAR has released evidence-basedrecommendations for managing cardiovascular risk in people with RA和其他类型的炎症性关节炎。这些指南均针对风湿病学家和全科医生。ACR似乎没有遵循诉讼，但随着生物制剂对RA的系统方面的影响的积累证据，这可能会在未来发生变化。希望它会导致风湿病学家在未来具有更全面的治疗RA观点。
您的初级保健医师是第一次接触与您的一般健康有关的问题，但大多数人都只有有限的关于RA的知识，特别是疾病的全身表现。在这方面，您对自己主张是很重要的。确保管理心脏病的风险是您的家庭医生提供给您的重要因素。
This can include establishing a baseline as early as possible in terms of your blood pressure, cholesterol and blood sugar so you can track changes over time. You should also have a conversation with your doctor about when to start other preventative tests, such as stress tests, balancing the need to stay vigilant with avoiding unnecessary tests. You may also want to talk to both your rheumatologist and your family doctor about whether a referral to a preventative cardiologist would be helpful in managing the risk. For most people, this may not be necessary, but if you have a number of risk factors, such as family history, high blood pressure, smoking, and being overweight, it may be worth considering.
这项研究表明，用抗TNF药物治疗的人们的心血管风险降低是非常好的新闻。本研究提供的证据和其他人表明，抑制RA的炎症对一般健康和预期寿命产生积极影响。提高对ra的全身方面的认识，包括心血管事件，将导致与疾病一起生活的人更好的保健。
December, 2015 update：在这篇文章写的三年内，RA人民的心血管健康继续改善。A recent study发现，在自2000年以来诊断的人中，心血管疾病死亡风险现在与一般人群相当。这种大规模改善的原因是更有效的治疗（可能的生物学），以前诊断的努力，以及对心血管风险的提高和警惕增加。
