الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Rheumatoid arthritis (RA) is an autoimmune disease that manifests mainly with articular symptoms, but the main cause of death is cardiovascular disease (CVD). chronic inflammation is thought to contribute both directly to CVD as well as indirectly to cardiometabolic risk factors such as insulin resistance, atherogenic lipid profile and sarcopenic obesity, all features of chronic active RA. Data on the presence of these risk factors in newly diagnosed RA are scarce but need to be defined so that they can be addressed if present in early disease.
The development of accelerated atherosclerosis and increased risk of CV disease in patients with RA may be influenced by the occurrence of MetS. Evidence concerning the prevalence of MetS in RA showed that MetS is significantly more prevalent in RA patients than in controls and evidence documented an association between RA disease activity and MetS. Thus, MetS might determine inflammatory milieu leading to the occurrence of more severe RA.
Although certain evidence states that insulin resistance is increased in long-term RA cases, it is not clear whether the development of insulin resistance accompanies the onset of symptoms or instead occurs subsequently due to poor disease control in some patients.
White adipose tissue-derived cytokines mediate between obesity-related exogenous factors (nutrition and lifestyle) and the molecular events that lead to the development of MetS, inflammation, and CV disease. In this regard, a complex adipokine-mediated interaction among white adipose tissue, CV disease, and RA has been described.
Visfatin is a recently identified adipokine; its circulating levels are directly correlated with increasing adiposity. They are also higher in RA patients compared with healthy controls. To date, very few studies have looked into the potential role of visfatin in RA activity and progression; however, a clear association between visfatin and pro-inflammatory pathways potentially leading to increased disease activity has been described.