Topic Highlight
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2014; 5(3): 304-311
Published online Jul 18, 2014. doi: 10.5312/wjo.v5.i3.304
Inflammation, lipid metabolism and cardiovascular risk in rheumatoid arthritis: A qualitative relationship?
Carmen García-Gómez, Maria Bianchi, Diana de la Fuente, Lina Badimon, Teresa Padró, Emili Corbella, Xavier Pintó
Carmen García-Gómez, Maria Bianchi, Department of Rheumatology, Consorci Sanitari de Terrassa (CST), Unitat Investigació Biomèdica CST-UAB (Universitat Autònoma de Barcelona), 08227-Terrassa, Barcelona, Spain
Diana de la Fuente, Department of Rheumatology, Hospital de Viladecans, 08840-Viladecans, Barcelona, Spain
Lina Badimon, Teresa Padró, Cardiovascular Research Center, CSIC-ICCC, Biomedical Research Institute Sant-Pau, 08025-Barcelona, Spain
Emili Corbella, Xavier Pintó, Lipid and Vascular Risk Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona University, 08907 Fipec, CIBERobn ISCIII, Spain
Author contributions: García-Gómez C conception, design and draft of the manuscript, and initial outline of the illustrations; Bianchi M development of the illustrations and bibliographic research; de la Fuente D bibliographic research and reference order; Badimon L, Padró T and Pintó X correction and critical review with contributions to improve the scientific quality of the manuscript and provide novel categories; Corbella E acquisition of research articles and data.
Correspondence to: Carmen García-Gómez, MD, PhD, Department of Rheumatology, Consorci Sanitari de Terrassa (CST), Unitat Investigació Biomèdica CST-UAB (Universitat Autònoma de Barcelona), Ctra, Torrebonica S/N, 08227-Terrassa, Barcelona, Spain.
Telephone: +34-93-7839488 Fax: +34-93-70003637
Received: December 27, 2013
Revised: February 26, 2014
Accepted: April 17, 2014
Published online: July 18, 2014

Life expectancy in patients with rheumatoid arthritis (RA) is reduced compared to the general population owing to an increase in cardiovascular diseases (CVD) not fully explained by traditional cardiovascular risk factors. In recent years, interest has been focused on the alterations in lipid metabolism in relation to chronic inflammation as one of the possible mechanisms involved in the pathogenesis of atherosclerosis of RA patients. Research regarding this issue has revealed quantitative alterations in lipoproteins during the acute-phase reaction, and has also demonstrated structural alterations in these lipoproteins which affect their functional abilities. Although many alterations in lipid metabolism have been described in this regard, these structural changes associated with inflammation are particularly important in high-density lipoproteins as they affect their cardioprotective functions. In this respect, excessive oxidation in low-density lipoprotein (LDL) and increased lipoprotein(a) with a predominance of smaller apolipoprotein(a) isoforms has also been reported. This article will discuss proinflammatory high-density lipoproteins (piHDL), oxidized LDL and lipoprotein(a). Elevated concentrations of these lipoproteins with marked pro-atherogenic properties have been observed in RA patients, which could help to explain the increased cardiovascular risk of these patients.

Keywords: Rheumatoid arthritis, Cardiovascular disease, Lipoproteins, Proinflammatory high-density lipoproteins, Lipoprotein(a), Oxidized low-density lipoproteins, Lipid metabolism, Inflammation

Core tip: Inflammation plays a major role in the process of accelerated atheromatosis in rheumatoid arthritis patients by modifying the structural and functional properties of lipoproteins.