الفهرس 
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Abstract
Aim of the work
In this work we are attempting to identify the risk of atherosclerosis in patients with RA and role of NSAIDs, steroid and DMARDs in the pathogenesis of atherosclerosis.
Conclusion
• RA patients have an increase in the prevalence of preclinical atherosclerosis, independent of traditional risk factors such as age, serum, cholesterol levels, and hypertension, suggesting that chronic inflammation is atherogenic in this population.
• This asymptotic atherosclerotic is evidenced by hyperlipidemia, presence of carotid plaques and increased carotid IMT and raised prevalence of CD4CD28null (%).
• No specific role for the prescribed drugs was found.
• Control of the disease itself save blood vessels and protect patients from subclinical dangerous effects of atherosclerosis.
Recommendations
• RA disease must be viewed as a systemic disease, not only an articular one. So, attention must be drawn to its serious extra-articular manifestations, the most important and dangerous of which is ATHEROSCLEROSIS.
• Atherosclerosis should be considered in every RA patient, especially with uncontrolled and long standing course.
• RA patients should be followed up by a serum lipid profile, CD4 CD28null (%) and carotid duplex annually. In addition, high risk RA patients for atherosclerosis, (e.g. elderly with long standing disease) can be revised by these investigations twice yearly.
• It is possible that monitoring the levels of inflammatory markers and cytokines markers through- out the disease course could substantially add to the prognostic information provided by the traditional risk factors and RA disease specific indicators.
• The early detection of vascular damage and the identification and the treatment of inflammatory risk factors may reduce the personal and economic burden of increased vascular diseases in RA.
• Patient selection rather than drug selectivity may thus be more important in such issue.
• Treatment strategies in RA should not only aim to relieve symptoms but should have a strict control of the disease activity with a beneficial effect on the vasculature to reduce CV events.
• Combat other RA risk factors: as low dose as possible from steroid, limited prescription of NSAIDs, combined MTX with folic acid, regular laboratory lipid test and prescription of statins treatment in accordance with current recommendations.
• The early diagnosis of endothelial dysfunction and atherosclerosis, active immunosuppressive treatment, the use of drugs that control atherosclerosis, change sedentary lifestyle, and the close follow up of RA patients may help to minimize CV risk in these individuals.