Abnormal retinal microvasculature found in active rheumatoid arthritis:a different perspective of microvascular health

Ocular markers of microangiopathy and their possible association with cardiovascular risk in patients with systemic inflammatory rheumatic diseases: a systematic review

Individuals with autoimmune rheumatic diseases (ARDs) are at a higher cardiovascular (CV) risk due to systemic inflammation, which contributes to endothelial dysfunction, atherosclerosis, and structural changes in the vessel walls. Along with traditional CV risk factors like dyslipidaemia, arterial hypertension, obesity, and impaired glucose metabolism, these patients have a severe prognosis with higher CV morbidity and mortality rates. To date, there is limited data on the optimal CV screening methods for individuals with ARDs, as conventional risk algorithms may underestimate the influence of chronic inflammation. In comparison to macrovascular assessment methods, such as carotid-femoral pulse wave velocity and carotid sonography, microvascular changes, which may precede macrovascular disease, have been less investigated. The ocular microvasculature reflects systemic vascular health and can reveal early signs of CV disease. Changes in retinal vessels have been linked to an increased long-term risk of CV mortality and ischemic stroke in longitudinal studies of the general population, such as the large Atherosclerosis Risk in Communities (ARIC) study. Additionally, various cross-sectional and follow-up studies in patients with ARDs have demonstrated associations between ocular vessel changes, traditional CV risk scores, and disease-related characteristics, suggesting a potential role for ocular assessments in CV risk screening. In this review work, research from 26 studies retrieved from the PubMed and Web of Science databases has been highlighted. Herein, we evaluate the techniques of retinal vessel analysis (RVA), optical coherence tomography angiography (OCT-A), spectral domain-OCT (SD-OCT), and retrobulbar color Doppler. Specifically, we examine the available data on their associations with key CV risk factors, systemic inflammation, surrogate CV markers, and traditional CV risk scores. Furthermore, we discuss their potential diagnostic value in both ARDs and the general population. Despite current limitations, such as small sample sizes and methodological heterogeneity, initial findings suggest that these techniques may provide valuable insights into microangiopathy and CV risk. Future research should focus on larger, well-designed longitudinal studies to establish their prognostic value and potential integration into clinical practice.

Retinal microvascular alterations in patients with active rheumatoid arthritis without cardiovascular risk factors: the potential effects of T cell co-stimulation blockade

Background

The evaluation of microvascular alterations might provide clinically useful information for patients with an increased cardiovascular (CV) risk, such as those with rheumatoid arthritis (RA), being the small artery remodeling the earliest form of target organ damage in primary CV diseases, such as arterial hypertension. The evaluation of retinal arterioles is a non-invasive technique aimed to identify an early microvascular damage, represented by the increase of the wall-to-lumen ratio (WLR) index. Abatacept (ABA), a T-cell co-stimulator blocker, is used to treat RA. A CV protective action was hypothesized for its peculiar mechanism of action in the modulation of T-cells, potentially involved in the pathogenesis of CV comorbidity. The study aimed to non-invasively investigate morphological characteristics of retinal arterioles in a cohort of RA patients treated with ABA.

Materials and methods

Seventeen RA patients [median (25th-75thpercentile) age = 58 (48-64) years, baseline 28-joint Disease Activity Score DAS28-C-reactive protein (DAS28-CRP) = 4.4 (3.9-4.6), body mass index (BMI) = 24.2 (23.4-26) kg/m2, rheumatoid factor positive:52.9%, anti-citrullinated peptide autoantibodies positive:76.5%] without known CV risk factors (arterial hypertension, diabetes, hypercholesterolemia, previous CV events, smoking) were evaluated by the adaptive optics imaging system of retinal arterioles before and every 6 months of therapy with ABA (T0, T6 and T12). Office blood pressure evaluation, 24-h ambulatory blood pressure monitoring and tissue-doppler echocardiography were also performed.

Results

A progressive significant reduction of the WLR of retinal arterioles was observed [T0 = 0.28 (0.25-0.30), T6 = 0.27 (0.24-0.31), T12 = 0.23 (0.23-0.26); p T0 vs. T6 = 0.414; p T6 vs. T12 = 0.02; p T0 vs. T12 = 0.009], without significant variations in other parameters. The T0-T12 reduction of WLR was correlated with that of DAS28-CRP (r:0.789; p = 0.005). Moreover, a significant reduction of diastolic office blood pressure and a trend for reduction of daily pressure measured by ambulatory monitoring were observed.

Conclusion

In a cohort of RA patients without known CV risk factors, a reduction of retinal microvascular alterations was demonstrated after treatment for 12 months with ABA, in parallel with the reduction of disease activity. These results might suggest the possibility of microvascular abnormalities regression induced by the immune system modulation.

Automated Retinal Vessel Analysis Based on Fundus Photographs as a Predictor for Non-Ophthalmic Diseases-Evolution and Perspectives

The study of retinal vessels in relation to cardiovascular risk has a long history. The advent of a dedicated tool based on digital imaging, i.e., the retinal vessel analyzer, and also other software such as Integrative Vessel Analysis (IVAN), Singapore I Vessel Assessment (SIVA), and Vascular Assessment and Measurement Platform for Images of the Retina (VAMPIRE), has led to the accumulation of a formidable body of evidence regarding the prognostic value of retinal vessel analysis (RVA) for cardiovascular and cerebrovascular disease (including arterial hypertension in children). There is also the potential to monitor the response of retinal vessels to therapies such as physical activity or bariatric surgery. The dynamic vessel analyzer (DVA) remains a unique way of studying neurovascular coupling, helping to understand the pathogenesis of cerebrovascular and neurodegenerative conditions and also being complementary to techniques that measure macrovascular dysfunction. Beyond cardiovascular disease, retinal vessel analysis has shown associations with and prognostic value for neurological conditions, inflammation, kidney function, and respiratory disease. Artificial intelligence (AI) (represented by algorithms such as QUantitative Analysis of Retinal vessel Topology and siZe (QUARTZ), SIVA-DLS (SIVA-deep learning system), and many others) seems efficient in extracting information from fundus photographs, providing prognoses of various general conditions with unprecedented predictive value. The future challenges will be integrating RVA and other qualitative and quantitative risk factors in a unique, comprehensive prediction tool, certainly powered by AI, while building the much-needed acceptance for such an approach inside the medical community and reducing the "black box" effect, possibly by means of saliency maps.

The importance of microvascular inflammation in ageing and age-related diseases: a position paper from the ESH working group on small arteries, section of microvascular inflammation

Microcirculation is pervasive and orchestrates a profound regulatory cross-talk with the surrounding tissue and organs. Similarly, it is one of the earliest biological systems targeted by environmental stressors and consequently involved in the development and progression of ageing and age-related disease. Microvascular dysfunction, if not targeted, leads to a steady derangement of the phenotype, which cumulates comorbidities and eventually results in a nonrescuable, very high-cardiovascular risk. Along the broad spectrum of pathologies, both shared and distinct molecular pathways and pathophysiological alteration are involved in the disruption of microvascular homeostasis, all pointing to microvascular inflammation as the putative primary culprit. This position paper explores the presence and the detrimental contribution of microvascular inflammation across the whole spectrum of chronic age-related diseases, which characterise the 21st-century healthcare landscape. The manuscript aims to strongly affirm the centrality of microvascular inflammation by recapitulating the current evidence and providing a clear synoptic view of the whole cardiometabolic derangement. Indeed, there is an urgent need for further mechanistic exploration to identify clear, very early or disease-specific molecular targets to provide an effective therapeutic strategy against the otherwise unstoppable rising prevalence of age-related diseases.

Effect of Eriodictyol on Collagen-Induced Arthritis in Rats by Akt/HIF-1α Pathway

Purpose

The aim of the experiment was to explore the effect of eriodictyol (ERI) on arthritis.

Methods

We established a rat model of collagen-induced rheumatoid arthritis (CIA) using type II collagen plus Freund’s complete adjuvant. We evaluated the degree of paw swelling, joint pathology, inflammatory cytokine levels, and the Akt/hypoxia-inducible factor (HIF)-1α signaling pathway in the CIA rats.

Results

ERI significantly ameliorated joint swelling; improved joint pathology; and suppressed the release of interleukin-6, interleukin-1 beta, and tumor necrosis factor-alpha. Moreover, ERI inhibited the Akt/HIF-1α pathway in the joints of rats and in lipopolysaccharide-treated RAW264.7 cells.

Conclusion

ERI ameliorated arthritis in a manner involving the Akt/HIF-1α signaling pathway.