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eOCaAieaeEau

eA‚IUOEI?E ?U?EU –
IOAI? UA?OU?OI·OA
O.a. cOOIO‚
oI.–IO??. eAac, O?OUAOOO?
Ei aIOUEUUU ?A‚IUOIO„EE eAac, aOOI‚
aaiaoieaiue a?o?eo (?A) – naiay ?anoay oi?ia o?iie?aneiai iieea?o?eoa e iaii ec iaeaieaa [2,10]. E iei ioiinyony: iaeiieaiea eeanne?aneeo ea?aeiaaneoey?iuo oaeoi?ia ?enea, iiai?iua yo-

? ?ani?ino?aiaiiuo a iiioeyoee ainiaeeoaeuiuo caaieaaaiee ?aeiaaea [1]. ?A i?eaiaeo ia oieu- oaeou eaea?noaaiiie oa?aiee (IIAI, ae?eiei?oeeieau, aaceniua i?ioeaiainiaeeoaeuiua i?aia?a-

ei e ?aiiae eiaaeeaiinoe, ii e e nie?aie? i?iaie?eoaeuiinoe ?ecie iaoeaioia n eieaaaieyie cia- ou n aioeoieaoiie aeoeaiinou? e a?.), eniieuco?uaeny aey ea?aiey ?A, iaainoaoi?iia aieiaiea e

?aiee noaiaa?oeciaaiiiai o?iaiy nia?oiinoe (NON) io 1,13 ai 5,15 [2]. Oaaee?aiea ?enea i?a?aaa?a- iaiaoiaeiinoe i?ioeeaeoeee ea?aeiaaneoey?iuo inei?iaiee i?e ?A. Iaiaei, ii iiaie? aieuoei-

iaiiie nia?oiinoe o iaoeaioia ?A annioee?oaony n oy?aeie eiaaeeaiinou?, yeno?aa?oeeoey?iuie noaa enneaaiaaoaeae, iniiaio? ?ieu ea?a?o iauea eiioiiainiaeeoaeuiua iaoaieciu, ea?auea a

(nenoaiiuie) i?iyaeaieyie, a oae?a aeoeaiinou? ainiaeeoaeuiiai i?ioanna e na?iiiceoeaiinou? ii iniiaa iaoiaaiaca ?A e aoa?ineea?ica [13–16], eioi?ue a ianoiyuaa a?aiy ?anniao?eaaaony, eae

?aaiaoieaiiio oaeoi?o (?O) [87]. A oaeii nia?oiinou i?e ?A ia 70% auoa, ?ai a iiioeyoee, e o «ainiaeeoaeuiia» caaieaaaiea ?aeiaaea [17].

iaoeaioia, no?aaa?ueo «oy?aeui» ?A, oaeay ?a, eae i?e o?aoninoaenoii ii?a?aiee ei?iia?iuo a?- ?acoeuoaou iniiaiuo yieaaieieiae?aneeo enneaaiaaiee, iinayuaiiuo ioaiea ?enea ea?aei-

oa?ee, eeioii?ieeoa?aoeaiuo iiooieyo, einoeuoa e naoa?iii aeaaaoa 2 oeia [3]. I?e ?A nouanoaai- aaneoey?iie iaoieiaee i?e ?A (oaae. 1), iicaieeee naaeaou i?eioeieaeuii aa?iue auaia i oii, ?oi

ii ia?anoaao ?anoioa niioonoao?ueo («eiii?aeaiuo») caaieaaaiee [4,5], ii iiaiao eioi?uo iaoeaiou, oaaee?aiea ?enea na?aa?ii–ninoaenouo caaieaaaiee i?e ?A iaaicii?ii iauynieou oieuei iaeiiea-

eae i?aaeei, iieo?a?o iaainoaoi?iia ea?aiea [6]. Ianiio?y ia ianiiiaiiua oniaoe a ea?aiee ?A, i?e- ieai o?aaeoeiiiuo ea?aeiaaneoey?iuo oaeoi?ia ?enea. Iniaue eioa?an i?aanoaaeyao enneaaiaaiea

aaaoea e nie?aie? eiaaeeaiinoe e oeo?oaie? ea?anoaa ?ecie, yoi ia iiaeaeei ca niaie nouanoaai- H. Maradit–Kremers e niaao. [23], a eioi?ii aiaeece?iaaeanu ?anoioa anaai niaeo?a naycaiiuo n aoa-

iiai oaaee?aiey i?iaie?eoaeuiinoe ?ecie iaoeaioia [7,8]. ?ineea?icii caaieaaaiee na?aa?ii–ninoaenoie nenoaiu, eae ai, oae e iinea ?acaeoey ?A. A yoii en-

Iniiaiay i?e?eia i?a?aaa?aiaiiie eaoaeuiinoe i?e ?A (i?eia?ii o iieiaeiu aieuiuo) – ca- neaaiaaiee auei aia?aua onoaiiaeaii ia?anoaiea ?enea EI (a oii ?enea aanneiioiiiiai) ai ?ac-

aieaaaiey na?aa?ii–ninoaenoie nenoaiu [8]. Oioy «?aaiaoieaiia» ii?a?aiea na?aoa (ia?eea?aeo, aa- aeoey eeeie?aneeo i?iyaeaiee ?A. Neaaoao iniai iia?a?eioou, ?oi ia?aniiciaiiue EI ninoaaeyao

neoeeo ei?iia?iuo a?oa?ee, ii?a?aiea eeaiaiia na?aoa) ia?aaei auyaeyaony ia aooiinee e i?e yoi- ieiei 30% anao neo?aaa EI o iaoeaioia n oaeeie caaieaaaieyie, eae naoa?iue aeaaao 2 oeia e o?i-

ea?aeia?aoe?aneii enneaaiaaiee, iii, eae i?aaeei, ia i?eaiaeo e aaiiaeiaie?anee cia?eiui ia?o- ie?aneay ii?a?iay iaainoaoi?iinou. A a?oaii enneaaiaaiee, auiieiaiiii yoie ?a a?oiiie aaoi?ia,

oaieyi e?iaiia?auaiey [9]. A ianoiyuaa a?aiy oaaaeoaeuii aieacaii, ?oi aaaouae i?e?eiie nie- auei oaaaeoaeuii aieacaii, ?oi oy?anou nenoaiiiai ainiaeeoaeuiiai i?ioanna (noieeia oaaee?aiea

?aiey i?iaie?eoaeuiinoe ?ecie i?e ?A yaey?ony ea?aeiaaneoey?iua inei?iaiey, naycaiiua n NIY> 60 ii/?, I?=2,3, ?aaiaoieaiue aaneoeeo, I?=2,41, ?aaiaoieaiia ii?a?aiea eaaeeo, I?=2,32)

aoa?ineea?ioe?aneei ii?a?aieai ninoaia (EI, canoieiay na?aa?iay iaainoaoi?iinou, aiacaiiay annioee?oaony n nouanoaaiiui oaaee?aieai ea?aeiaaneoey?iie eaoaeuiinoe (n iii?aaeie ia o?aae-

nia?ou) [10,11]. I?e yoii oaaee?aiea ea?aeiaaneoey?iie caaieaaaaiinoe e eaoaeuiinoe eiaao ianoi oeiiiua ea?aeiaaneoey?iua oaeoi?u ?enea e iaee?ea niioonoao?ueo caaieaaaiee) [87].

ia oieuei o iaoeaioia, aeeoaeuii no?aaa?ueo ?A, ii e a ia?aua aiau caaieaaaiey, iniaaiii o ?ai- N?aae o?aaeoeiiiuo ea?aeiaaneoey?iuo oaeoi?ia ?enea iniaia cia?aiea eiaao eo?aiea, ei-

uei, na?iiiceoeaiuo ii ?O [12]. oi?ia i?aa?aniieaaaao e ?acaeoe? ia oieuei aoa?ineea?ioe?aneiai ii?a?aiey ninoaia, ii e ?A [25].

Ii aaiiui iiioeyoeiiiiai enneaaiaaiey (256 000 e?aae a aic?anoa 45–75 eao), eo?aiea – aaeino-
Iano?aaaony ianeieuei acaeiinaycaiiuo i?e?ei, i?eaiayueo e oaaee?aie? ?enea ea?aeiaa-

aaiiue o?aaeoeiiiue ea?aeiaaneoey?iue oaeoi? ?enea, auyaeyaiue o iaoeaioia ai ?acae-
neoey?iuo eaoano?io, naycaiiuo n onei?aiiui aoa?ineea?ioe?aneei ii?a?aieai ninoaia i?e ?A


Oaaeeoa 1. ?acoeuoaou eiio?iee?oaiuo enneaaiaaiee ?enea EAN i?e ?A


c
S.E. Gabriel
Eiai?oiia REP E?eoa?ee ACR (n=450) Aeaaiic a?a?a (n=111) 1,35
et al. [18]
I. Del Rincon Ainieoaeecaoey ii iiaiao
Eiai?oiia ORALE E?eoa?ee ACR (n=236) 3,96
et al. [19] EI (n=7)+AEO+einoeuo
Eiai?oiia (10 eao Ii?iniee iaoeaioia, Ii?iniee iaoeaioa,
D.H. Solomon
i?iniaeoeaiiai NHS aaeeae?iaaiiue ii EI+aiacaiiay nia?ou 2,0
et al. [20]
iaae?aaiey) e?eoa?eyi ACR (n=527) (n=2296)
Ii?iniee iaoeaioa+
F. Wolfe Aeaaiic ?aaiaoieiaa aaeeae?iaaiiay
Iaiiiiiaioiia NDB 2,14
et al. [21] (n=9093) iaaeoeineay
aieoiaioaoey (50%)
Eiai?oiia (4,5 aiaa Aeaaiic a?a?a
D.J. Watson Aeaaiic a?a?a
i?iniaeoeaiiai GPRD (ia aaeeae?iaai) 1,6
et al. [22] (ia aaeeae?iaai)
iaae?aaiey) (n=11623)
L.M. Fischer Neo?ae–eiio?ieu Aeaaiic a?a?a Aeaaiic a?a?a
GPRD 1,47
et al. [23] (EI) (ia aaeeae?iaai) (n=770) (?anoe?ii aaeeae?iaai)
:
Aaeeae?iaaiiay – ino?ue EI – 3,17
iaaeoeineay – ia?aniiciaiiue EI – 5,86;
Maradit–H. Eiai?oiia
aieoiaioaoey (EI, – noaiiea?aey – 0,58
Kremers (i?iniaeoeaiia REP E?eoa?ee ACR (n=603)
iia?aoee ia ei?iia?iuo :
et al. [24] iaae?aaiea, 2 aiaa)
a?oa?eyo, noaiiea?aey, – ia?aniiciaiiue EI – 2,13
aiacaiiay nia?ou) – aiacaiiay nia?ou – 1,94
– AEO – 0,36
I?eia?aiea: ACR– American College Rheumatology; REP–Rochester Epidemiology Project; ORALE– The Outcome of Rheumatoid Arthritis Longitudinal
Evaulation; NHS – Nurses`s Health Study; GRPD – General Practice Research Database


509

13, 8, 2005
eOCaAieaeEau
oey a?o?eoa [26]. I Del Rincon e niaao. [46], i?e ?A iaae?aaaony ainoiaa?iay eeiaeiay ei??aeyoey ia?ao oieueiie EEI

Ia?ooaiea eeieaiiai niaeo?a i?e ?A iaiiieiaao oaeiaua i?e a?oaeo ainiaeeoaeuiuo e ei- niiiuo a?oa?ee (a oae?a ?anoioie iaia?o?aiey aeyoae a niiiuo a?oa?eyo) e NIY e N?A – iacaaeneii

oaeoeiiiuo caaieaaaieyo (nie?aiea eiioaio?aoee ON EIAI) e ei??aee?oao n aeoeaiinou? ainiaee- io iiea e aic?anoa iaoeaioia e iaee?ey ea?aeiaaneoey?iuo oaeoi?ia ?enea. I?eia?aoaeuii, ?oi ?ac-

oaeuiiai i?ioanna (oaaee?aieai o?iaiy NIY e eiioaio?aoee N?A) [27,28]. I?eia?aoaeuii, ?oi i?e ?A ee?ey a oieueia EEI o iaoeaioia n ieieiaeuiui e iaeneiaeuiui oaaee?aieai NIY ninoaaeea >0,200

nie?aiea NIY ia oiia i?ioeaiainiaeeoaeuiie oa?aiee annioee?oaony n ii?iaeecaoeae eiioaio?a- ii. A i?aauaoueo enneaaiaaieyo auei iieacaii, ?oi ?acee?ea a oieueia EEI 0,200 ii niioaaonoaoao

oee «aioeaoa?iaaiiiai» ON EIAI [29]. 2–e?aoiiio oaaee?aie? ?enea ea?aeiaaneoey?iuo inei?iaiee. Oioy aanie?oiua ?acee?ey ia?ao oie-

A?oa?eaeuiay aeia?oaicey (AA) – iaeaieaa ?anoia «eiii?aeaiia» ninoiyiea i?e ?A, iau?ii ueiie EEI o iaoeaioia n ?A e a eiio?iea ninoaaeee 0,050 ii e auee noaoenoe?anee ia ainoiaa?iuie,

?acaeaaaony oiia caaieaaaiey [30] e ia?aaei naycaii n i?eaiii ianoa?ieaiuo i?ioeaiainiaeeoaeuiuo yoi niioaaonoaoao ?acee?e? a oieueia EEI o eo?eeuueeia e ia eo?yueo. E?iia oiai, oaaee?aiea oie-

i?aia?aoia (IIAI) [31]. A?oaei aa?iui oaeoi?ii ?enea, eioi?ue ?anoi auyaeyaony i?e ?A [33] – ei- ueiu EEI ia 0,050 ii annioee?oaony n ia?anoaieai ?anoiou na?aa?ii–ninoaenouo inei?iaiee ia 59%.

noeeii?acenoaioiinou, a iniiaa eioi?iai ia?aaei ea?eo o?iie?aneee ainiaeeoaeuiue i?ioann [32]. Ei- I?e enneaaiaaiee a aeiaieea (?a?ac 18–36 ian.) o iaoeaioia oaaee?aiea oieueiu EEI aieaa au?a?a-

noeeii?acenoaioiinou ?anoi iaia?o?eaaaony i?e ?A e ei??aee?oao n aeoeaiinou? ainiaeaiey [33]. ii, ?ai a eiio?iea, e ei??aee?oao n N?A e NIY, a oae?a eaai?aoi?iuie ia?ea?aie einoiie aano?oeoee

Aeia?aiiioenoaeiaiey – iioaioeaeuii iiaeoeoe?oaiue oaeoi? ?enea aoa?ineea?ica [34], [50].

ia?aaei iaae?aaaony i?e ?A [35,36], ?aua o iaoeaioia n niioonoao?ueie ea?aeiaaneoey?iuie ca- Aenooieoey yiaioaeey, ?anniao?eaa?uayny eae iaeaieaa ?aiiee «i?aaeeoi?» aoa?ineea?i-

aieaaaieyie. Ioia?aia naycu ia?ao aeia?aiiioenoaeiaieae e i?eaiii «aaceniuo» i?ioeaiainia- oe?aneiai ii?a?aiey ninoaia [52,53], auyaeyaony i?e ?A eae ia ?aiiae, oae e iicaiae noaaeyo caai-

eeoaeuiuo i?aia?aoia – iaoio?aenaoa e noeuoanaeaceia [36]. eaaaiey, iacaaeneii io aeoeaiinoe aieacie e iaee?ey ea?aeiaaneoey?iuo oaeoi?ia ?enea [54–57]. I

I?e ?A iaae?aaaony oaaee?aiea eiioaio?aoee ?yaa ia?ea?ia aeia?eiaaoeyoee (oea?eiiaai, ?iee ainiaeaiey a ?acaeoee aenooieoee yiaioaeey naeaaoaeunoao?o aaiiua ?yaa aaoi?ia i ii?ia-

oeaiaaie aeoeaaoi? ieacieiiaaia, eiaeaeoi? oeaiaaiai aeoeaaoi?a ieacieiiaaia oeia 1, D–aeia?a e eecaoee yoiai iieacaoaey ia oiia ea?aiey iiiieeiiaeuiuie aioeoaeaie e OII–? (eioeeeneiaa)

oaeoi?a oii Aeeeaa?aiaa) [37], eioi?ua ii aaiiui yieaaieieiae?aneeo enneaaiaaiee annioee?o- [58,59]. S. Van Dorum e niaao. [60] iaia?o?eee iaee?ea yiaioaeeaeuiie aenooieoee n eniieuciaaie-

?ony n ?eneii ea?aeiaaneoey?iuo inei?iaiee. ai iaoiaa, iniiaaiiiai ia aiaeeca ioeuniaie aieiu iae?i– e iee?ininoaia. I?eia?aoaeuii, ?oi

A iineaaiea aiau iauaeoii eioaineaiuo enneaaiaaiee noaiiayony eiioiieiae?aneea ia?- i?eciaee iee?ininoaenoie iaainoaoi?iinoe oi?ioi ei??aee?iaaee n eiaaenii Oa?ia, io?a?a?uei

ea?u aoa?ineea?ica. E iei ioiinyony aaeee ino?ie oacu ainiaeaiey (N–?aaeoeaiue aaeie, nuai- oy?anou ii?a?aiey nonoaaia i?e ?A. Ii aaiiui M. Wong e niaao. [61], o iaoeaioia n ?A iaae?aaaony

?ioi?iue aieeieaiue aaeie A), iieacaoaee aeoeaaoee eiioieoaoa (i?iainiaeeoaeuiua oeoieeiu, eo ainoiaa?iia nie?aiea yeanoe?iinoe iaeeeo e e?oiiuo ninoaia e oaaee?aiea nenoaiiie ninoaenoie

?anoai?eiua ?aoaioi?u, iaiioa?ei) e aenooieoee yiaioaeey (eeaoi?iua iieaeoeu aaaacee, oaeoi? ?acenoaioiinoe ii n?aaiaie? n eiio?ieai. I?e yoii auyaeaia ia?aoiay ei??aeyoey ia?ao eiioaio-

Aeeeaa?aiaa e a?.), i?aaiiianiaoeoe?iua aooiaioeoaea (iai?eia?, aioeoaea e oinoieeieaai e ?aoeae N?A (a oae?a nuai?ioi?iiai aieeieaiiai aaeea A) e ia?aiao?aie ninoaenoie yeanoe?iinoe e

ieeneaiiiio eeiii?ioaeio ieceie ieioiinoe) e eiioiiua eiiieaenu [38–40]. Iiiaea ec ieo, n iaiie ninoaenoie ?acenoaioiinoe, a oae?a ia?ao eiioaio?aoeae ?anoai?eiie ninoaenoie iieaeoeu aaaa-

noi?iiu, yaey?ony «i?aaeeoi?aie» ea?aeiaaneoey?iuo eaoano?io a iiioeyoee, a eo o?iaaiu ei??a- cee–1 (?VCAM–1) e ninoaenoie ?acenoaioiinou?. Noiaiua aaiiua i nouanoaaiiii oaaee?aiee nino-

ee?oao n ?acaeoeai AA, ?acenoaioiinoe e einoeeio e a?oaeie eeanne?aneeie ea?aeiaaneoey?iuie aenoie ?acenoaioiinoe e oaio?aeuiiai e?iayiiai aaaeaiey o iaoeaioia n ?A, ia eia?ueo o?aaeoe-

oaeoi?aie ?enea [40,41], a n a?oaie – io?a?a?o o?iie?aneee ainiaeeoaeuiue i?ioann i?e ?A eee ya- iiiuo ea?aeiaaneoey?iuo oaeoi?ia ?enea, iaia?o?eee a?oaea aaoi?u [62,63]. «I?aaeeoi?aie» ea?-

ey?ony aai o?anoeaie. aeiaaneoey?iuo inei?iaiee i?e ?A yaey?ony nie?aiea eiau?a?ii–iea?aaiai eiaaena e aai?anney

Iniaia cia?aiea i?eaa?o N?A, aa?a iaaieuoia oaaee?aiea eiioaio?aoee eioi?iai (auyaeyao- naaiaioa QT ii aaiiui nooi?iiai iiieoi?e?iaaiey YEA ii Oieoa?o [51,65]. I?e enneaaiaaiee ia?-

ny oieuei n iiiiuu? auniei?oanoaeoaeuiuo iaoiaia) io?a?aao «noaeeeie?aneia» (eaoaioiia) ninoae- oocee ieiea?aa n iiiiuu? iaiioioiiiie yienneiiiie eiiiu?oa?iie oiiia?aoee a oneiaeyo oa?-

noia ainiaeaiea e annioee?oaony n oaaee?aieai ?enea ea?aeiaaneoey?iuo eaoano?io o «oneiaii» cai- iaeieiae?aneiai no?anna i?eciaee noaaeeuiie EAN auee iaia?o?aiu o 59% iaoeaioia n ?A ii n?aa-

?iauo io??ei e ?aiuei, a o iaoeaioia n EAN annioee?oaony n ?acaeoeai iaoaaiee?aneiai neia?iia e iaie? n 27% a eiio?ieuiie a?oiia [64].

naoa?iiai aeaaaoa 2 oeia [41]. Eco?aiea eiioiieiae?aneeo ia?ea?ia aoa?ineea?ica iicaieeei ii–ii- Iaeioi?ua eaea?noaaiiua n?aanoaa, eniieuco?ueany aey ea?aiey ?A, iiaoo ieacuaaou iioai-

aiio iiaieoe e ioaiea oaeoi?ia ?enea na?aa?ii–ninoaenouo caaieaaaiee, i?iaiice?iaaie? inei?ia- oeaeuii iaaaoeaiia aeeyiea ia ninoaenoo? noaieo, naa?ouaaiea e?iae e AA e oai naiui oaaee?eaaou

iee (aoa?io?iiaic) e enoiaia aoa?ineea?ioe?aneiai i?ioanna. Yoa i?iaeaia i?aanoaaeyaony iniaaiii ?ene ea?aeiaaneoey?iuo inei?iaiee, ii yoio iaaaoeaiue yooaeo ii?ao eiiiaine?iaaouny eo «aioe-

aeooaeuiie a naaoa aaiiuo i oii, ?oi o iieiaeiu iaoeaioia ea?aeiaaneoey?iua inei?iaiey ?acaeaa- aoa?iaaiiui» aaenoaeai, ca n?ao iiaaaeaiey «ainiaeeoaeuiiai» eiiiiiaioa aoa?io?iiaica. Aa?io?

?ony a ionoonoaea «eeanne?aneeo» oaeoi?ia ?enea [42]. Auoa o?a oiiieiaeinu enneaaiaaiea H. ?ieu a ?aaoeyoee ninoaenoiai aiiainoaca ea?a?o i?iaoeou a?aoeaiiiaie eeneiou – i?inoaoeeeei

Maradit–Kremers e niaao. [23], a eioi?ii auei auyaeaii oaaee?aiea ?enea ea?aeiaaneoey?iuo inei?ia- (?GI2) e o?iiaienai (TxA2). Iiyoiio eco?aiea ea?aeiaaneoey?iuo yooaeoia IIAI i?aanoaaeyao ia-

iee ai ia?aea ?A i?e ionoonoaee eeanne?aneeo ea?aeiaaneoey?iuo oaeoi?ia ?enea. A nayce n yoei aa?- niiiaiiue eioa?an [66]. Aa?iyoii, iniaaiii cia?eiuie iioaioeaeuiua «ninoaenoua» yooaeou IIAI

iia cia?aiea eia?o aaiiua i oii, ?oi oaaee?aiea eiioaio?aoee N?A e «aoa?iaaiiue» i?ioeeu ee- (e eiaeaeoi?ia OIA–2) iiaoo auou o eeo n iiauoaiiui ?eneii ea?aeiaaneoey?iuo inei?iaiee, a oii

ieaia auyaey?ony o iaoeaioia n ?A ai eeeie?aneie iaieoanoaoee caaieaaaiey [43]. I?iniaeoea- ?enea n ?A. Aaenoaeoaeuii, a iineaaiea aiau iiyaeeenu aaiiua, naeaaoaeunoao?uea ia oaaee?aiee

iua enneaaiaaiey, eana?ueany nayce ia?ao o?iaiai «eiioiieiae?aneeo» ia?ea?ia aoa?ineea?ica e ?enea o?iiaicia o iaoeaioia n ?A, iieo?aaoeo eiaeaeoi?u OIA–2. Aaenoaeoaeuii, enoiay ec oai?a-

?acaeoeai ea?aeiaaneoey?iuo eaoano?io, i?e ?A ai neo ii? ia i?iaiaeeenu. Oai ia iaiaa, ii aaiiui oe?aneeo i?aaiinueie, aaenoaea eiaeaeoi?ia OIA–2 eae au i?ioeaiiiei?ii yooaeoo ieceeo aic aoa-

eiai?oiiai enneaaiaaiey (a ?aieao i?ia?aiiu NHS), iaoeaiou n ?A (n=287) ia ioee?aeenu io iiioey- oeenaeeoeeiaie eeneiou: nie?aiea OIA–2 caaeneiiai neioaca PGI2 eeaoeaie ninoaenoiai yiaioaeey,

oeiiiiai eiio?iey (n=87 019) ii ?anoioa ea?aeiaaneoey?iuo oaeoi?ia ?enea (eiaaen iannu oaea, aea- a ionoonoaea aeeyiey ia OIA–1 caaeneiue neioac ToA2 o?iiaioeoaie. Yoi iioaioeaeuii ii?ao i?e-

aao, AA, naiaeiue aiaiiac, eiaaen oece?aneie aeoeaiinoe, eiioaio?aoey ON, ON EIII, o?eaeeoa?eau, aiaeou e ia?ooaie? aaeaina PGI2/ToA2 e a ?acoeuoaoa yoiai – e aeoeaaoee o?iiaioeoia e oaaee?aie?

aiieeiii?ioaei A, EI(a), aiiioenoaei) (p>0,05 ai anao neo?ayo) 44]. A a?oiia iaoeaioia n ?A aue aieaa ?enea o?iiaiia?aciaaiey. Iaaaaii auei iioaeeeiaaia na?ey niiauaiee ia oaaee?aiee ?enea ea?ae-

aunieee i?ioaio eo?eeuueeia e eeo, i?eieia?ueo aeeiaieu. A oi ?a a?aiy n?aaiee o?iaaiu eaai?a- iaaneoey?iuo inei?iaiee ia oiia i?eaia eiaeaeoi?ia OIA–2 – ?ioaeieneaa e oaeaeieneaa [66–67],

oi?iuo iieacaoaeae, io?a?a?ueo ea?aeiaaneoey?iue ?ene a iauae iiioeyoee «oneiaii» cai?iauo e?- oioy eeeie?aneia cia?aiea yoeo aaiiuo o?aaoao aaeuiaeoaai eco?aiey. Iano?aa?ony ea?aeiaaneo-

aae e aieuiuo n EAN, oaeeo eae N?A, oea?eiiaai, ?anoai?eiay (?) oi?ia ia?eeaoi?iie iieaeoeu aa- ey?iua yooaeou ae?eiei?oeeieaia [71], ea?aiea eioi?uie nio?aiyao nai? aeooaeuiinou i?e ?A

aacee–1 (?ICAM–1), ?anoai?eiua ?aoaioi?u OII–? oeia I e II e inoaii?ioaaa?ei, auee ainoiaa?ii au- [72–73]. Ii aaiiui enneaaiaaiey «neo?ae–eiio?ieu», a eioi?ia auee aee??aiu iaoeaiou n ?A (a oae-

?a o?iie?aneeie iano?oeoeaiuie caaieaaaieyie eaaeeo), i?eai ae?eiei?oeeieaia annioee?oaony
oa i?e ?A, ?ai a eiio?iea.

n ia?aeaoaeuiuie ea?aeiaaneoey?iuie e oa?aa?iaaneoey?iuie enoiaaie (I?=1,21) (iniaaiii
A ianoiyuaa a?aiy aey ?aiiae aeaaiinoeee aoa?ineea?ioe?aneiai ii?a?aiey ninoaia e ioaiee

?enea ea?aeiaaneoey?iuo ninoaenouo inei?iaiee eniieucoaony oe?ieee niaeo? iaeiaaceaiuo eino?o- aey eeo, i?iaie?a?ueo i?eieiaou yoe i?aia?aou), ?acaeoeai na?aa?iie iaainoaoi?iinoe (I?=2,66) e

iaioaeuiuo iaoiaia. N?aae ieo iniaaiii eioi?iaoeaii ii?aaaeaiea oieueiu eiiieaena eioe- ieieiaeuiui (I?=1,22) oaaee?aieai ?enea ino?iai ei?iia?iiai neia?iia [74]. Onoaiiaeaii oae?a,

ia–iaaea (EEI) niiiuo (?a?a – aaa?aiiie) a?oa?ee n iiiiuu? oeuo?acaoeiaiai enneaaiaaiey n auni- ?oi o iaoeaioia ?A, i?eieia?ueo ae?eiei?oeeieau, ?aua iaia?o?eaa?ony aoa?ineea?ioe?aneea

eei ?ac?aoaieai, iineieueo oaaee?aiea oieueiu EEI ei??aee?oao n ?eneii ea?aeiaaneoey?iuo in- aeyoee a niiiuo a?oa?eyo, a oae?a auyaeyaony oaiaaioey e oaaee?aie? oieueiu EEI niiiuo a?oa-

ei?iaiee [45]. O iaoeaioia n ?A oieueia EEI ainoiaa?ii aieuoa, ?ai a eiio?iea [46–51], e annioee- ?ee (n iii?aaeie ia o?aaeoeiiiua ea?aeiaaneoey?iua oaeoi?u ?enea e eeeie?aneea iniaaiiinoe ca-

?oaony n aeeoaeuiinou? caaieaaaiey, aano?oeoeae nonoaaia, eiaaeeaiinou? (eiaaena HAQ). Ii aaiiui aieaaaiey) ii n?aaiaie? n iaoeaioaie, ia iieo?aaoeie ae?eiei?oeeieau [75]. Ae?eiei?oeeieaiay




510 13, 8, 2005
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10. Van Dorum S, McColl G, Wicks IP. Accelerated atherosclerosis. An extraarticular feature of rheumatoid arthritis. Arthritis
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?a a?aiy eia?ony aaiiua i oii, ?oi ea?aiea ae?eiei?oeeieaaie (a ni?aoaiee n AIAI) o iaoeaioia n
12. Goodson NJ, Wiles NJ, Lunt M, et al. Mortality in Early inflammatory polyarthritis. Cardiovascular mortality is increased
?A i?eaiaeo e ii?iaeecaoee ia?ooaiiiai niioiioaiey ON/ON EIAI («aoa?iaaiiue» eiaaen), ia?ae-
in seropositive patients. Arthritis Rheum 2002; 46: 2010–2019
eaeuii ni nie?aieai aeoeaiinoe ?A [77], oi anou ieacuaaao «aioeaoa?iaaiiue» yooaeo. A yoii eii-

oaenoa i?aanoaaey?o eioa?an iaoa?eaeu 18–eaoiaai i?iniaeoeaiiai iaae?aaiey ca 1240 iaoeaioaie
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n ?A, a eioi?ii auei iieacaii, ?oi ea?aiea iaoio?aenaoii (iaeaieaa yooaeoeaiue ec i?eiaiyaiuo 14. Sattar N, McCrey DW, Capell H, McInnes IB. Explaining how «high–grade» systemic inflammation accelerated vascular

risk in rheumatoid arthritis. Circulation 2003; 108: 2957–2963
a ianoiyuaa a?aiy noaiaa?oiuo AIAI) annioee?oaony ni nie?aieai iauae (ia 60%) e ea?aeiaaneo-
15. Manzi S, Wasko MC. Inflammation–mediated rheumatic disease and atherosclerosis. Ann Rheum Dis 2000; 59: 321–325.
ey?iie (ia 70%) nia?oiinoe [78], ianiio?y ia niiniaiinou i?aia?aoa eiaooe?iaaou aeia?aiiioenoae-
16. cOOIO‚ O.a. e?O·IAI UA?OU?OI·OA ‚ ?A‚IUOIO„EE. CAOUIEI eAac 2003; 7: 6–10
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18. Gabriel SE, Crowson CS, Kremers HM, et al. Survival in rheumatoid arthritis: a population–based analysis of trends over
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19. Del Rincon I, Williams K, Stern MP, et al. High incidence of cardiovascular events in a rheumatoid arthritis cohort not
?A [79]. I?aaaa?eoaeuiua ?acoeuoaou naeaaoaeunoao?o i oii, ?oi o iaoeaioia ?A, iieo?aaoeo ei-
explained by traditional cardiac risk factors. Arthritis Rheum 2001; 12: 1237–2745
oeeeneiaa, iaae?aaaony nie?aiea ?enea ia?aiai ea?aeiaaneoey?iiai inei?iaiey [80]. Eae o?a
20. Solomon DH, Karlson EW, Rimm EB, et al. Cardiovascular morbidity and mortality in women diagnosed with rheumatoid
ioia?aeinu, ea?aiea eioeeeneiaaii i?eaiaeo e ii?iaeecaoee yiaioaeee–caaeneiie aaciaeeaoaoee,
arthritis. Circulation 2003; 107: 1303–1307
?oi ei??aee?oao ni nie?aieai ainiaeeoaeuiie aeoeaiinoe aieacie [58]. Eia?ony aaiiua, ?oi aaaaa-

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