EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome

被引:245
作者
Drosos, George C. [1 ]
Vedder, Daisy [2 ]
Houben, Eline [3 ]
Boekel, Laura [2 ]
Atzeni, Fabiola [4 ]
Badreh, Sara [5 ]
Boumpas, Dimitrios T. [6 ,7 ]
Brodin, Nina [8 ,9 ]
Bruce, Ian N. [10 ,11 ]
Gonzalez-Gay, Miguel Angel [12 ,13 ]
Jacobsen, Soren [14 ,15 ]
Kerekes, Gyorgy [16 ]
Marchiori, Francesca [17 ]
Mukhtyar, Chetan [18 ]
Ramos-Casals, Manuel [19 ]
Sattar, Naveed [20 ]
Schreiber, Karen [21 ]
Sciascia, Savino [22 ]
Svenungsson, Elisabet [23 ,24 ]
Szekanecz, Zoltan [25 ]
Tausche, Anne-Kathrin [26 ]
Tyndall, Alan [27 ]
van Halm, Vokko [28 ]
Voskuyl, Alexandre [29 ]
Macfarlane, Gary J. [30 ]
Ward, Michael M. [31 ]
Nurmohamed, Michael T. [2 ,32 ]
Tektonidou, Maria G. [1 ,7 ]
机构
[1] Natl & Kapodistrian Univ Athens, Laiko Hosp, Dept Propaedeut Internal Med 1, Athens, Greece
[2] Reade, Amsterdam Rheumatol & Immunol Ctr, Amsterdam, Netherlands
[3] Northwest Clin, Dept Internal Med, Alkmaar, Netherlands
[4] Univ Messina, Dept Internal Med, Rheumatol Unit, Messina, Italy
[5] EULAR Patient Res Partner, Brussels, Belgium
[6] Attikon Univ Hosp, Dept Internal Med 4, Athens, Greece
[7] Natl & Kapodistrian Univ Athens, Med Sch, Joint Acad Rheumatol Program, Athens, Greece
[8] Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Physiotherapy, Huddinge, Sweden
[9] Danderyd Hosp Corp, Dept Orthopaed, Stockholm, Sweden
[10] Univ Manchester, Ctr Musculoskeletal Res, Ctr Epidemiol Versus Arthrit, Manchester, Lancs, England
[11] Manchester Univ Hosp NHS Trust, Manchester Acad Hlth Sci Ctr, NIHR Manchester Biomed Res Ctr, Manchester, Lancs, England
[12] Hosp Univ Marques Valdecilla, Rheumatol Div, Santander, Spain
[13] Univ Cantabria, Santander, Spain
[14] Rigshosp, Copenhagen Lupus & Vasculitis Clin, Copenhagen, Denmark
[15] Univ Copenhagen, Fac Hlth Sci, Dept Clin Med, Copenhagen, Denmark
[16] Univ Debrecen, Dept Med, Intens Care Unit, Debrecen, Hungary
[17] EULAR Patient Res Partner, Rome, Italy
[18] Norfolk & Norwich Univ Hosp, Rheumatol Dept, Colney Lane, Norwich, Norfolk, England
[19] Univ Barcelona, Hosp Clin, ICMiD, Dept Autoimmune Dis, Barcelona, Spain
[20] Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Lanark, Scotland
[21] Danish Hosp Rheumat Dis, Sonderburg, Denmark
[22] Univ Torino, San Giovanni Bosco Hosp, CMID Nephrol, Turin, Italy
[23] Karolinska Inst, Rheumatol Unit, Dept Med, Stockholm, Sweden
[24] Karolinska Univ Hosp, Stockholm, Sweden
[25] Univ Debrecen, Fac Med, Dept Rheumatol, Debrecen, Hungary
[26] Tech Univ Dresden, Univ Clin Carl Gustav Carus, Dept Rheumatol, Dresden, Germany
[27] Univ Basel, Dept Rheumatol, Basel, Switzerland
[28] Locat VU Univ, Med Ctr, Amsterdam Univ, Dept Cardiol, Amsterdam, Netherlands
[29] Vrije Univ, Amsterdam UMC, Dept Rheumatol & Clin Immunol, Amsterdam, Netherlands
[30] NHS Grampian, Dept Publ Hlth, Aberdeen, Scotland
[31] NIAMSD, Intramural Res Program, NIH, Bethesda, MD 20892 USA
[32] Locat VU Univ, Med Ctr, Amsterdam Univ, Amsterdam, Netherlands
关键词
autoimmune diseases; cardiovascular diseases; lupus erythematosus; systemic; systemic vasculitis; antiphospholipid syndrome; GIANT-CELL ARTERITIS; C-REACTIVE PROTEIN; CORONARY-HEART-DISEASE; 2021; AMERICAN-COLLEGE; MYOCARDIAL-INFARCTION; VASCULAR EVENTS; GOUT; MORTALITY; PREDICTORS; COHORT;
D O I
10.1136/annrheumdis-2021-221733
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective To develop recommendations for cardiovascular risk (CVR) management in gout, vasculitis, systemic sclerosis (SSc), myositis, mixed connective tissue disease (MCTD), Sjogren's syndrome (SS), systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Methods Following European League against Rheumatism (EULAR) standardised procedures, a multidisciplinary task force formulated recommendations for CVR prediction and management based on systematic literature reviews and expert opinion. Results Four overarching principles emphasising the need of regular screening and management of modifiable CVR factors and patient education were endorsed. Nineteen recommendations (eleven for gout, vasculitis, SSc, MCTD, myositis, SS; eight for SLE, APS) were developed covering three topics: (1) CVR prediction tools; (2) interventions on traditional CVR factors and (3) interventions on disease-related CVR factors. Several statements relied on expert opinion because high-quality evidence was lacking. Use of generic CVR prediction tools is recommended due to lack of validated rheumatic diseases-specific tools. Diuretics should be avoided in gout and beta-blockers in SSc, and a blood pressure target <130/80 mm Hg should be considered in SLE. Lipid management should follow general population guidelines, and antiplatelet use in SLE, APS and large-vessel vasculitis should follow prior EULAR recommendations. A serum uric acid level <0.36 mmol/L (<6 mg/dL) in gout, and disease activity control and glucocorticoid dose minimisation in SLE and vasculitis, are recommended. Hydroxychloroquine is recommended in SLE because it may also reduce CVR, while no particular immunosuppressive treatment in SLE or urate-lowering therapy in gout has been associated with CVR lowering. Conclusion These recommendations can guide clinical practice and future research for improving CVR management in rheumatic and musculoskeletal diseases.
引用
收藏
页码:768 / 779
页数:12
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