الفهرس 
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Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology marked by a symmetric, peripheral polyarthritis.
Several investigators reported an excess of cardiovascular morbidity and mortality among rheumatoid arthritis patients. The majority of cardiovascular deaths results from accelerated atherosclerosis. Elevated plasma total cholesterol and low-density lipoprotein cholesterol, decreased high-density lipoprotein cholesterol are strong factors for atherosclerotic events.
Our study designed for showing changes of serum lipid profile in patients with rheumatoid arthritis relative to disease activity and to look for any correlation between lipid profile parameters and different inflammatory markers and duration of the disease.
In our study the parameters of lipid profile correlated significantly with CRP, disease duration and DAS28. Our study revealed that the rheumatoid factor, CRP and ESR were higher in patients with RA than in control group with very highly significant difference.
Total cholestrol, LDL were highly significantly higher in patients with RA activity. HDL was significantly lower in control patients than the RA patients with a significant difference. Regarding total cholesterol and HDL-C the mean atherogenic ratio of TC /HDL-C was higher in patients with RA than in control group with very highly significant difference.
More discriminating tools for identifying RA patients with a higher risk of cardiovascular disease are needed.
Recommendations
Rheumatoid arthritis (RA) should be regarded as a condition associated with higher risk for CV disease. The increased risk appears to be due to both an increased prevalence of traditional risk factors and the inflammatory burden.
Adequate control of disease activity is necessary to lower the CV risk.
CV risk assessment using national guidelines is recommended for all patients with RA. Risk assessments should be repeated when anti-rheumatic treatment has been changed.
Risk score models should be adapted for patients with RA by introducing a 1.5 multiplication factor (Peters et al., 2010). This multiplication factor should be used when the patient with RA meets two of the following three criteria:
(i) Disease duration >10 years, (ii) RF or anti-CCP positivity and (iii) The presence of certain extra-articular manifestations.
TCh/HDL cholesterol ratio should be used when the SCORE model is used.
Intervention should be carried out according to national guidelines.
Statins, ACE inhibitors and/or AT-II blockers are preferred treatment options.
The role of coxibs and most NSAIDs in CV risk is not well established and needs further investigation. Hence we should be very cautious about prescribing them, especially for patients with a documented CV disease or in the presence of CV risk factors.
Using corticosteroids in the lowest dose possible.
Smoking should be stopped.