Skip to main content

Advertisement

SpringerLink
Log in

Cardiovascular and Metabolic Comorbidities in Rheumatoid Arthritis

  • Rheumatoid Arthritis (L Moreland, Section Editor)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

An increased prevalence of cardiovascular risk factors in rheumatoid arthritis (RA) is reported. The absolute cardiovascular risk in RA patients is higher than in the general population, and although the RA prognosis has gradually improved, premature cardiovascular (CV) mortality remains a matter of fact. The purpose of this review is to shed light on CV and metabolic involvement in RA, with the aim of defining its best management.

Recent Findings

Multiple lines of evidence have revealed common mechanisms behind inflammatory and CV diseases and clarified the metabolic and CV pathways involved in RA and the effects of different pharmacological treatments.

Summary

CV risk assessment should be mandatory in all RA patients, taking into account the impact of both diseases on patient’s prognosis. Therefore, a multidisciplinary approach is the best management, and rheumatologists, cardiologists, and general practitioners must work together to significantly improve outcome and quality of life in RA patients. Future research could investigate the potential beneficial effects of a more aggressive pharmacological treatment of CV and metabolic risk factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Peters MJL, Symmons DP, McCarey D, Dijkmans BA, Nicola P, Kvien TK, et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis. 2010;69:325–31.

    CAS  PubMed  Google Scholar 

  2. Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJ, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders 2015/2016 update. Vol. 76, pp. 17–28.

  3. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37:2129–200.

    Article  Google Scholar 

  4. Nurmohamed MT, Heslinga M, Kitas GD. Cardiovascular comorbidity in rheumatic diseases. Nat Rev Rheumatol. 2015;11:693–704.

    CAS  PubMed  Google Scholar 

  5. Cobbs S, Anderson F, Bauer W. Length of life and cause of death in rheumatoid arthritis. N Engl J Med. 1953;249:553–6.

    Google Scholar 

  6. Gabriel SE, Crowson CS, Kremers HM, Doran MF, Turesson C, O'Fallon WM. Survival in rheumatoid arthritis: a population-based analysis of trends over 40 years. Arthritis Rheum. 2003;48:54–8.

    PubMed  Google Scholar 

  7. Widdifield J, Bernatsky S, Paterson JM, Tomlinson G, Tu K, Kuriya B, et al. Trends in excess mortality among patients with rheumatoid arthritis in Ontario, Canada. Arthritis Care Res. 2015;67(8):1047–53.

    Google Scholar 

  8. Avouac J, Amrouche F, Meune C, Rey G, Kahan A, Allanore Y. Mortality profile of patients with rheumatoid arthritis in France and its change in 10 years. Semin Arthritis Rheum. 2017;46(5):537–43.

    PubMed  Google Scholar 

  9. Humphreys JH, Warner A, Chipping J, Marshall T, Lunt M, Symmons DP, et al. Mortality trends in patients with early rheumatoid arthritis over 20 years: results from the Norfolk Arthritis Register. Arthritis Care Res. 2014;66(9):1296–301.

    CAS  Google Scholar 

  10. Dadoun S, Zeboulon-Ktorza N, Combescure C, Elhai M, Rozenberg S, Gossec L. Mortality in rheumatoid arthritis over the last fifty years: systematic review and meta-analysis. Joint Bone Spine. 2013;80(1):29–33.

    PubMed  Google Scholar 

  11. Avina-Zubieta JA, Thomas J, Sadatsafavi M, Lehman AJ, Lacaille D. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis. 2012;71:1524–9.

    PubMed  Google Scholar 

  12. Meune C, Touzé E, Trinquart L, Allanore Y. Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies. Rheumatology. 2009;48:1309–13.

    PubMed  Google Scholar 

  13. Myasoedova E, Davis JM 3rd, Crowson CS, Gabriel SE. Epidemiology of rheumatoid arthritis: rheumatoid arthritis and mortality. Curr Rheumatol Rep. 2010;12(5):379–85.

    PubMed  Google Scholar 

  14. Solomon DH, et al. Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation. 2003;107:1303–7.

    PubMed  Google Scholar 

  15. Levy L, et al. Incidence and risk of fatal myocardial infarction and stroke events in rheumatoid arthritis patients. A systematic review of the literature. Clin Exp Rheumatol. 2008;26:673–9.

    CAS  PubMed  Google Scholar 

  16. Turesson C, et al. (2004) Increased incidence of cardiovascular disease in patients with rheumatoid arthritis: results from a community based study. Ann Rheum Dis, pp. 952–955.

  17. Nicola PJ, et al. The risk of congestive heart failure in rheumatoid arthritis: a population-based study over 46 years. Arthritis Rheum. 2005;52:412–20.

    PubMed  Google Scholar 

  18. Maradit-Kremers H, et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum. 2005;52(2):402–11.

    PubMed  Google Scholar 

  19. Bartoloni E, et al. How early is the atherosclerotic risk in rheumatoid arthritis? Autoimmun Rev. 2010;9(10):701–7.

    CAS  PubMed  Google Scholar 

  20. Kerola AM, et al. No increased cardiovascular mortality among early rheumatoid arthritis patients: a nationwide register study in 2000–2008. ClinExp Rheumatol. 2015;33:391–8.

    Google Scholar 

  21. Gonzalez A, et al. 2008Do cardiovascular risk factors confer the same risk for cardiovascular outcomes in rheumatoid arthritis patients as in non-rheumatoid arthritis patients? Ann Rheum Dis. 67:64–9.

  22. Stampfer MJ, et al. A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction. N Engl J Med. 1991;325:373–81.

    CAS  PubMed  Google Scholar 

  23. Choy E, Sattar N. Interpreting lipid levels in the context of high grade inflammatory states with a focus on rheumatoid arthritis: a challenge to conventional cardiovascular risk actions. Ann Rheum Dis. 2009;68:460–9.

    CAS  PubMed  Google Scholar 

  24. Myasoedova E, et al. Lipid paradox in rheumatoid arthritis:the impact of serum lipid measures and systemic inflammation on the risk of cardiovascular disease. Ann Rheum Dis. 2011;70(3):482–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Liao KP, et al. Lipid and lipoprotein levels and trends in rheumatoid arthritis compared to the general population. Arthritis Care Res. 2013;65(12):2046–50.

    CAS  Google Scholar 

  26. Liao KP, et al. The association between lipid levels and major adverse cardiovascular events in rheumatoid arthritis compared to non-RA. Arthritis Rheum. 2015;67(8):2004–10.

    CAS  Google Scholar 

  27. Zhang J, et al. The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis. Ann Rheum Dis. 2014;73(7):1301–8.

    CAS  PubMed  Google Scholar 

  28. Plutzky J, et al. Lipids in RA: is less not necessarily more? Curr Rheumatol Rep. 2018;20(2):8.

    PubMed  PubMed Central  Google Scholar 

  29. Robertson J, et al. Changes in lipid levels with inflammation and therapy in RA: a maturing paradigm. Nat Rev Rheumatol. 2013;9:513–23.

    CAS  PubMed  Google Scholar 

  30. •• Charles-Schoeman C, et al. Potential mechanisms leading to the abnormal lipid profile in patients with rheumatoid arthritis versus healthy volunteers and reversal by tofacitinib. Arthritis Rheum. 2015;67(3):616–25.

    CAS  Google Scholar 

  31. •• Robertson J, et al. Interleukin-6 blockade raises LDL via reduced catabolism rather than via increased synthesis: a cytokine-specific mechanism for cholesterol changes in rheumatoid arthritis. Ann Rheum Dis. 2017;76(11):1949–52 These two studies showed that during the active phase of the disease LDL-C catabolism increases, explaining cholesterol levels fluctuations that characterize the natural history of the disease and its treatment.

    CAS  PubMed  Google Scholar 

  32. Toms TE, et al. Are lipid ratios less susceptible to change with systemic inflammation than individual lipid components in patients with rheumatoid arthritis? Angiology. 2011;62:167–75.

    CAS  PubMed  Google Scholar 

  33. Favari E, et al. Cholesterol efflux capacity (CEC): an index of atheroprotective activity of HDL? Giornale Italiano dell’Arteriosclerosi. 2014;5(3):3–8.

    Google Scholar 

  34. • Liao KP, et al. The association between reduction in inflammation and HDL cholesterol efflux capacity in rheumatoid arthritis. J AmHeart Assoc. 2015;4(2):e001588 This study shed light on another mechanism involved in lipids regulation in RA patients, demonstrating that disease-modifying antirheumatic drugs improve HDL cholesterol efflux capacity.

    Google Scholar 

  35. Navarro-Millan I, et al. Changes in lipoproteins associated with methotrexate or combination therapy in early rheumatoid arthritis: results from the treatment of early rheumatoid arthritis trial. Arthritis RheumVolucella. 2013;65(6):1430–8.

    CAS  Google Scholar 

  36. Chung CP, et al. Inflammation-associated insulin resistance: differential effects in rheumatoid arthritis and systemic lupus erythematosus define potential mechanisms. Arthritis Rheum. 2008;58:2105–12.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Donath MY, et al. Type 2 diabetes as an inflammatory disease. Nat Rev Immunol. 2011;11:98–107.

    CAS  PubMed  Google Scholar 

  38. Zuliani G, et al. Insulin resistance and systemic inflammation but not metabolic syndrome phenotype, predict 9 years mortality in older adults. Atherosclerosis. 2014;235:538–45.

    CAS  PubMed  PubMed Central  Google Scholar 

  39. • Ruscitti P, et al. Prevalence of type 2 diabetes and impaired fasting glucose in patients affected by rheumatoid arthritis: results from a cross-sectional study. Medicine. 2017;96(34):e7896 This study has pointed out that RA is significantly associated with glucose metabolism abnormalities, possibly leading to a metabolic syndrome, and that they correlate with disease duration and articular damage extension.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Ruscitti P, et al. Poor clinical response in rheumatoid arthritis is the main risk factor for diabetes development in the short term: a 1-year, single center, longitudinal study. PlosOne. 2017;12(7):e0181203.

    Google Scholar 

  41. Solomon DH, et al. Association between disease-modifying antirheumatic drugs and diabetes risk in patients with rheumatoid arthritis and psoriasis. JAMA. 2011;305:2525–31.

    CAS  PubMed  Google Scholar 

  42. Stavropoulos-Kalinoglou A, et al. Anti-tumour necrosis factor α therapy improves insulin sensitivity in normal-weight but not in obese patients with rheumatoid arthritis. Arthritis Res Ther. 2012;14:R160.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Panoulas VF, et al. Prevalence and associations of hypertension and its control in patients with rheumatoid arthritis. Rheumatology (Oxford). 2007;46:1477–82.

    CAS  Google Scholar 

  44. Ruscitti P, et al. Increased cardiovascular events and subclinical atherosclerosis in rheumatoid arthritis patients: 1 year prospective single centre study. PLoS One. 12(1):e0170108.

  45. O’Brien. Twenty-four-hour ambulatory blood pressure measurement in clinical practice and research: a critical review of a technique in need of implementation. J Intern Med. 2011;269:478–95.

    PubMed  Google Scholar 

  46. Cicek Y, et al. Non-dipping pattern in untreated hypertensive patients is related to increased pulse wave velocity independent of raised nocturnal blood pressure. Blood Press. 2013;22:34–8.

    PubMed  Google Scholar 

  47. Cuspidi C, et al. Nondipping pattern and carotid atherosclerosis: a systematic review and meta-analysis. J Hypertens. 2016;34:382–5.

    Google Scholar 

  48. Wong M, et al. Reduced arterial elasticity in rheumatoid arthritis and the relationship to vascular disease risk factors and inflammation. Arthritis Rheum. 2003;48:81–9.

    PubMed  Google Scholar 

  49. Panoulas VF, et al. Polymorphisms of the endothelin-1 gene associate with hypertension in patients with rheumatoid arthritis. Endothelium. 2008;15:203–2012.

    CAS  PubMed  Google Scholar 

  50. Rollefstad S, et al. Treatment to lipid targets in patients with inflammatory joint diseases in a preventive cardio-rheuma clinic. Ann Rheum Dis. 2013;72:1968–74.

    CAS  PubMed  Google Scholar 

  51. Solomon A, et al. Obesity and carotid atherosclerosis in African black and Caucasian women with established rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther. 2012;14:R67.

    PubMed  PubMed Central  Google Scholar 

  52. Kremers HM, et al. Prognostic importance of low body mass index in relation to cardiovascular mortality in rheumatoid arthritis. Arthritis Rheum. 2004;50:3450–7.

    PubMed  Google Scholar 

  53. Tournadre A, et al. Metabolic profile during interleukin 6 inhibition in rheumatoid arthritisChanges in bodycomposition. J Cachexia Sarcopenia Muscle. 2017;8(4):639–46.

    PubMed  PubMed Central  Google Scholar 

  54. Metsios GS, et al. Association of physical inactivity with increased cardiovascular risk in patients with rheumatoid arthritis. Eur J Cardiovasc Prev Rehabil. 2009;16:188–94.

    PubMed  Google Scholar 

  55. Sandberg ME, et al. Patients with regular physical activity before onset of rheumatoid arthritis present with milder disease. Ann Rheum Dis. 2014;73(8):1541–4.

    PubMed  Google Scholar 

  56. Crepaldi G, et al. Cardiovascular Comorbidities Relate More than Others with Disease Activity in Rheumatoid Arthritis. PLoS One. 2016;11:e0146991.

    PubMed  PubMed Central  Google Scholar 

  57. Gonzalez A, et al. Do cardiovascular risk factors confer the same risk for cardiovascular outcomes in rheumatoid arthritis patients as in nonrheumatoid arthritis patients? Ann Rheum Dis. 2008;67:64–9.

    CAS  PubMed  Google Scholar 

  58. Yusuf S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–52.

    PubMed  Google Scholar 

  59. Choi HK, et al. Selection bias in rheumatic disease research. Nat Rev Rheumatol. 2014;10:403–12.

    PubMed  PubMed Central  Google Scholar 

  60. Hollan I, et al. Cardiovascular disease in autoimmune rheumatic diseases. Autoimmun Rev. 2013;12:1004–15.

    CAS  PubMed  Google Scholar 

  61. Libby P, et al. Clinical implications of inflammation for cardiovascular primary prevention. Eur Heart J. 2010;31(7):777–83.

    CAS  PubMed  Google Scholar 

  62. • Ruscitti P, et al. Subclinical atherosclerosis and history of cardiovascular events in Italian patients with rheumatoid arthritis.Results from a cross-sectional, multicenter GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) study. Medicine. 2017;96(42):e8180 This cross sectional study points out the need of a good control of RA activity to prevent the occurrence of cardiovascular comorbidities.

    PubMed  PubMed Central  Google Scholar 

  63. Arts EE, et al. The effect of disease duration and disease activity on the risk of cardiovascular disease in rheumatoid arthritis patients. Ann Rheum Dis. 2015;74:998–1003.

    CAS  PubMed  Google Scholar 

  64. Soubrier M, et al. Cardiovascular risk in rheumatoid arthritis. Joint Bone Spine. 2014;81:298–302.

    PubMed  Google Scholar 

  65. Giacomelli R, et al. IL-1β at the crossroad between rheumatoid arthritis and type 2 diabetes: may we kill two birds with one stone? Expert Rev Clin Immunol. 2016;12:849–55.

    CAS  PubMed  Google Scholar 

  66. Pasceri V, et al. 1999 A tale of two diseases: atherosclerosis and rheumatoid arthritis. [editorial comment]. Circulation, Vol. 100(21), pp. 2124–6.

  67. Hollan I, et al. Vascular inflammation in systemic rheumatic diseases. Curr Med Lit Rheumatol. 2011;30(2):33–45.

    Google Scholar 

  68. Maes M, et al. Increased autoimmune activity against 5-HT: a key component of depression that is associated with inflammation and activation of cell-mediated immunity, and with severity and staging of depression. J Affect Disord. 2012;136(3):386–92.

    CAS  PubMed  Google Scholar 

  69. Clark IA, et al. The roles of TNF in brain dysfunction and disease. Pharmacol Ther. 2010;128(3):519–48.

    CAS  PubMed  Google Scholar 

  70. •• Arts EE, et al. Performance of four current risk algorithms in predicting cardiovascular events in patients with early rheumatoid arthritis. Ann Rheum Dis. 2015;74:668–74 This study has highlighted the inadequacy of commonly used cardiovascular risk stratification models in estimating CV risk in RA patients.

    CAS  PubMed  Google Scholar 

  71. Crowson CS, et al. Usefulness of risk scores to estimate the risk of cardiovascular disease in patients with rheumatoid arthritis. Am J Cardiol. 2012;110(3):420–4.

    PubMed  PubMed Central  Google Scholar 

  72. Gómez-Vaquero C, et al. SCORE and REGICOR function charts underestimate the cardiovascular risk in Spanish patients with rheumatoid arthritis. Arthritis Res Ther. 2013;15:R91.

    PubMed  PubMed Central  Google Scholar 

  73. Goodson NJ, et al. Mortality in early inflammatory polyarthritis:cardiovascular mortality is increased in seropositive patients. Arthritis Rheum. 2002;46:2010–9.

    PubMed  Google Scholar 

  74. Hannawi S, et al. Atherosclerotic disease is increased in recent-onset rheumatoid arthritis: a critical role for inflammation. Arthritis Res Ther. 2007;9:R116.

    PubMed  PubMed Central  Google Scholar 

  75. Corrales A, et al. Carotid ultrasound is useful for the cardiovascular risk stratification of patients with rheumatoid arthritis: results of a population-based study. Ann Rheum Dis. 2014;73:722–7.

    PubMed  Google Scholar 

  76. Peters MJL, et al. The interplay between infammation, lipids and cardiovascular risk in rheumatoid arthritis: why ratios may be better. Int J Clin Pract. 2010;64(10):1440–3.

    CAS  PubMed  Google Scholar 

  77. Pingiottii E, et al. Surface expression of fractalkine receptor (CX3CR1) on CD4+/CD28- T cells in RA patients and correlation with atherosclerotic damage. Ann N Y Acad Sci. 2007;1107:32–41.

    Google Scholar 

  78. Evans MR, et al. Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis. Arthritis Rheum. 2011;63(5):1211–20.

    PubMed  PubMed Central  Google Scholar 

  79. Ajeganova S, et al. Atheroprotective natural antibodies for cardiovascular disease in early rheumatoid arthritis—an inception cohort study. J Rheumatol. 2012;39(6):1146–54.

    PubMed  Google Scholar 

  80. Piepoli MF, et al. European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J. 2016;37:2315–81.

    PubMed  PubMed Central  Google Scholar 

  81. Ray KK, et al. The ACC/AHA 2013 guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: the good the bad and the uncertain: a comparison with ESC/EAS guidelines for the management of dyslipidaemias 2011. Eur Heart J. 2014;35:960–8.

    PubMed  Google Scholar 

  82. Metsios GS, et al. Individualised exercise improves endothelial function in patients with rheumatoid arthritis. Ann Rheum Dis. 2014;73:748–51.

    PubMed  Google Scholar 

  83. Lemmey AB, et al. Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial. Arthritis Rheum. 2009;61:1726–34.

    PubMed  Google Scholar 

  84. Stavropoulos-Kalinoglou A, et al. Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis. Ann Rheum Dis. 2013;72:1819–25.

    CAS  PubMed  Google Scholar 

  85. Estruch R, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279–90.

    CAS  PubMed  Google Scholar 

  86. Sköldstam L, et al. An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Ann Rheum Dis. 2003;62:208–14.

    PubMed  PubMed Central  Google Scholar 

  87. Catapano AL, et al. 2016 ESC/EAS guidelines for the management of dyslipidemias. Eur Heart J. 2016;37:2999–3058.

    PubMed  Google Scholar 

  88. Roubille C, et al. The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2015;74(3):480–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  89. del Rincón I, et al. Glucocorticoid dose thresholds associated with all-cause and cardiovascular mortality in rheumatoid arthritis. Ann Rheum Dis. 2014;66:264–72.

    Google Scholar 

  90. van Sijl AM, et al. Confounding by indication probably distorts the relationship between steroid use and cardiovascular disease in rheumatoid arthritis: results from a prospective cohort study. PLoS One. 2014;9(1):e87965.

    PubMed  PubMed Central  Google Scholar 

  91. Howes LG, et al. Selective COX-2 inhibitors, NSAIDs and cardiovascular events – is celecoxib the safest choice? Ther Clin Risk Manag. 2007;3(5):831–45.

    CAS  PubMed  PubMed Central  Google Scholar 

  92. Lindhardsen J, et al. Non-steroidal anti-inflammatory drugs and risk of cardiovascular disease in patients with rheumatoid arthritis: a nationwide cohort study. Ann Rheum Dis. 2014;73(8):1515–21.

    CAS  PubMed  Google Scholar 

  93. Bulgarelli A, et al. Treatment with methotrexate inhibits atherogenesis in cholesterol-fed rabbits. J Cardiovasc Pharmacol. 2012;59(4):308–14.

    CAS  PubMed  Google Scholar 

  94. Souto A, et al. Lipid profile changes in patients with chronic inflammatory arthritis treated with biologic agents and tofacitinib in randomized clinical trials: a systematic review and meta-analysis. Arthritis Rheum. 2015;67:117–27.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiology, Department of Life, Health and Environmental Sciences|, University of L’Aquila, L’Aquila, Italy

    Silvio Romano, Elisa Salustri & Maria Penco

  2. Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100, L’Aquila, Italy

    Piero Ruscitti, Francesco Carubbi & Roberto Giacomelli

Authors
  1. Silvio Romano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elisa Salustri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Piero Ruscitti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesco Carubbi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria Penco
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Roberto Giacomelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roberto Giacomelli.

Ethics declarations

Conflict of Interest

The authors declare that there are no conflicts of interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Financial Disclosure

The authors received no specific funding for this work.

Additional information

Topical Collection on Rheumatoid Arthritis

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Romano, S., Salustri, E., Ruscitti, P. et al. Cardiovascular and Metabolic Comorbidities in Rheumatoid Arthritis. Curr Rheumatol Rep 20, 81 (2018). https://doi.org/10.1007/s11926-018-0790-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11926-018-0790-9

Keywords

Search

Navigation