Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country

ABSTRACT: Background: It is plausible that optimal cardiovascular disease (CVD) risk management differs in patients with rheumatoid arthritis (RA) from low or middle income compared to high income populations. This study aimed at producing evidence-based points to consider for CVD prevention in South African RA patients. Methods: Five rheumatologists, one cardiologist and one epidemiologist with experience in CVD risk management in RA patients, as well as two patient representatives, two health professionals and one radiologist, one rheumatology fellow and 11 rheumatologists that treat RA patients regularly contributed. Systematic literature searches were performed and the level of evidence was determined according to standard guidelines. Results: Eighteen points to consider were formulated. These were grouped into 6 categories that comprised overall CVD risk assessment and management (n=4), and specific interventions aimed at reducing CVD risk including RA control with disease modifying anti-rheumatic drugs, glucocorticoids and non-steroidal anti-inflammatory drugs (n=3), lipid lowering agents (n=8), antihypertensive drugs (n=1), low dose aspirin (n=1) and lifestyle modification (n=1). Each point to consider differs partially or completely from recommendations previously reported for CVD risk management in RA patients from high income populations. Currently recommended CVD risk calculators do not reliably identify South African black RA patients with very high-risk atherosclerosis as represented by carotid artery plaque presence on ultrasound. Conclusions: Our findings indicate that optimal cardiovascular risk management likely differs substantially in RA patients from low or middle income compared to high income populations. There is an urgent need for future multicentre longitudinal studies on CVD risk in black African patients with RA.The first meeting held amongst local Rheumatologists was funded by the South African Arthritis and Rheumatology Association. The studies by Professor González-Gay have been supported by grants from “Fondo de Investigaciones Sanitarias” PI06/0024, PS09/00748, PI12/00060, PI15/00525, PI18/00043, and RD12/0009/0013 and RD16/0012 (RIER) from “Instituto de Salud Carlos III” (ISCIII) (Spain), co-funded by FEDER funds

Observation of the Kapitza-Dirac Effect

In their famous 1927 experiment, Davisson and Germer observed the diffraction of electrons by a periodic material structure, so showing that electrons can behave like waves. Shortly afterwards, Kapitza and Dirac predicted that electrons should also be diffracted by a standing light wave. This Kapitza-Dirac effect is analogous to the diffraction of light by a grating, but with the roles of the wave and matter reversed. The electron and the light grating interact extremely weakly, via the ‘ponderomotive potential,’ so attempts to measure the Kapitza-Dirac effect had to wait for the development of the laser. The idea that the underlying interaction with light is resonantly enhanced for electrons in an atom led to the observation that atoms could be diffracted by a standing wave of light. Deflection of electrons by high-intensity laser light, which is also a consequence of the Kapitza-Dirac effect, has also been demonstrated. But the coherent interference that characterizes wave diffraction has not hitherto been observed. Here we report the diffraction of free electrons from a standing light wave—a realization of the Kapitza-Dirac effect as originally proposed