Scholarlink

Background <p>Chronic inflammatory rheumatic diseases are associated with an increased risk of cardiovascular diseases (CVD), which significantly contribute to an increased morbidity and mortality. Although international recommendations exist, disease-specific and pragmatic guidance for the routine clinical practice are lacking due to heterogeneous evidence and incompletely understood pathophysiological mechanisms of cardiovascular events.</p> Objective <p>The aim was to develop an expert consensus providing practical recommendations for the prevention, screening and management of the increased cardiovascular risk in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondyloarthritis (SpA).</p> Methods <p>Between 2023 and 2025 a&#xa0;multidisciplinary panel of 21&#xa0;experts (rheumatology, cardiology, radiology, nephrology and endocrinology) convened under the Working Group “Rheumatism and Heart” of the Austrian Society for Rheumatology and Rehabilitation. A&#xa0;structured workflow was developed through iterative meetings and refined using a&#xa0;Delphi process. A&#xa0;total of 50&#xa0;statements were rated on a&#xa0;10-point Likert scale; all achieved &gt; 90% level of agreement after revision. The final consensus was consolidated into a&#xa0;structured clinical workflow.</p> Results <p>The panel proposes a&#xa0;three-phase cardiovascular care model. Phase&#xa0;1 (initial diagnosis of a rheumatic disease) emphasizes rapid achievement of remission, consideration of cardiovascular effects of antirheumatic treatment and early lifestyle counselling. The cardiovascular profiles of antirheumatic drugs are summarized in a&#xa0;heat map. Phase&#xa0;2 (rheumatic disease with low disease activity or in remission) focuses on systematic cardiovascular risk screening from age ≥ 40&#xa0;years using SCORE2 or SCORE2-OP, with a&#xa0;disease-specific multiplication factor of&#xa0;1.5 for RA, PsA and radiographic axial SpA. Patients are stratified into risk categories defined by the European Society of Cardiology (ESC), with defined upgrade criteria. Phase&#xa0;3 (advanced diagnostics and primary prevention) links risk categories to low-density lipoprotein (LDL)-cholesterol targets and tailored diagnostics aiming for early detection of atherosclerosis, arrhythmias and heart failure. In cases of a&#xa0;low risk for atherosclerosis blood pressure monitoring should be performed, at moderate risk additional carotid ultrasound and at high or very high risk an additional electrocardiography (ECG). To screen for heart failure a liberal amino-terminal pro-brain natriuretic peptide (NT-proBNP) measurement is recommended and in cases of elevated results or specific questions selective echocardiography is recommended. Opportunistic screening through pulse palpation is also recommended for patients at increased risk of atrial fibrillation. The ECG or electronic devices can provide evidence of arrhythmias and conduction abnormalities.</p> Conclusion <p>This consensus provides a&#xa0;structured, disease-specific and pragmatic approach to cardiovascular risk management in RA, PsA and SpA. By integrating inflammation control of the underlying disease, risk stratification and tailored diagnostics, it aims to improve early detection and prevention of cardiovascular comorbidities in routine rheumatological practice.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Konsensus-Statement der Österreichischen Gesellschaft für Rheumatologie und Rehabilitation zum Management des erhöhten kardiovaskulären Risikos bei rheumatoider Arthritis, Psoriasisarthritis und Spondyloarthritis

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年4月2日

查看全文
  • Boris Lindner,
  • Mathias Ausserwinkler,
  • Christina Siess,
  • Kai Ammerer,
  • Monika Esposito,
  • Josef Hermann,
  • Rainer Hintenberger,
  • Matthias Komposch,
  • Lukas Lanser,
  • Helga Lechner-Radner,
  • Caroline Peter,
  • Gersina Rega-Kaun,
  • David Reinhart-Mikocki,
  • Simon Schedl,
  • Michaela Stögerer-Lanzenberger,
  • Jens Thiel,
  • Alexander Niessner

摘要

Background

Chronic inflammatory rheumatic diseases are associated with an increased risk of cardiovascular diseases (CVD), which significantly contribute to an increased morbidity and mortality. Although international recommendations exist, disease-specific and pragmatic guidance for the routine clinical practice are lacking due to heterogeneous evidence and incompletely understood pathophysiological mechanisms of cardiovascular events.

Objective

The aim was to develop an expert consensus providing practical recommendations for the prevention, screening and management of the increased cardiovascular risk in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondyloarthritis (SpA).

Methods

Between 2023 and 2025 a multidisciplinary panel of 21 experts (rheumatology, cardiology, radiology, nephrology and endocrinology) convened under the Working Group “Rheumatism and Heart” of the Austrian Society for Rheumatology and Rehabilitation. A structured workflow was developed through iterative meetings and refined using a Delphi process. A total of 50 statements were rated on a 10-point Likert scale; all achieved > 90% level of agreement after revision. The final consensus was consolidated into a structured clinical workflow.

Results

The panel proposes a three-phase cardiovascular care model. Phase 1 (initial diagnosis of a rheumatic disease) emphasizes rapid achievement of remission, consideration of cardiovascular effects of antirheumatic treatment and early lifestyle counselling. The cardiovascular profiles of antirheumatic drugs are summarized in a heat map. Phase 2 (rheumatic disease with low disease activity or in remission) focuses on systematic cardiovascular risk screening from age ≥ 40 years using SCORE2 or SCORE2-OP, with a disease-specific multiplication factor of 1.5 for RA, PsA and radiographic axial SpA. Patients are stratified into risk categories defined by the European Society of Cardiology (ESC), with defined upgrade criteria. Phase 3 (advanced diagnostics and primary prevention) links risk categories to low-density lipoprotein (LDL)-cholesterol targets and tailored diagnostics aiming for early detection of atherosclerosis, arrhythmias and heart failure. In cases of a low risk for atherosclerosis blood pressure monitoring should be performed, at moderate risk additional carotid ultrasound and at high or very high risk an additional electrocardiography (ECG). To screen for heart failure a liberal amino-terminal pro-brain natriuretic peptide (NT-proBNP) measurement is recommended and in cases of elevated results or specific questions selective echocardiography is recommended. Opportunistic screening through pulse palpation is also recommended for patients at increased risk of atrial fibrillation. The ECG or electronic devices can provide evidence of arrhythmias and conduction abnormalities.

Conclusion

This consensus provides a structured, disease-specific and pragmatic approach to cardiovascular risk management in RA, PsA and SpA. By integrating inflammation control of the underlying disease, risk stratification and tailored diagnostics, it aims to improve early detection and prevention of cardiovascular comorbidities in routine rheumatological practice.