**9. Conclusion**

Sexual health and intimate relationships need further attention among health professionals, since many individuals with RA have decreased sexual health which can affect their intimate relationships negatively, and thereby decrease their general wellbeing and overall happiness. Each profession has a professional expertise that can assist RA patients in this field. Optimal treatment of RA can decrease sexual health problems for persons with RA,

Sexual Health and Intimate Relationships in Rheumatoid Arthritis 231

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since the difficulties are often connected with clinical disease activity. In order to give holistic care to persons with RA it is important to have a strategy within the rheumatological team on how to communicate and address problems concerning sexual health, and to acknowledge the need to protect, support and restore the sexual health of RA patients. To enhance the communication of sexual health there are useful communication models that are appropriate to rheumatological care.

#### **10. Acknowledgment**

We would like to acknowledge Futurum- the Academy for Healthcare, County Council, Jönköping, Sweden, for funding the authors' research in sexual health and RA.

#### **11. References**


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We would like to acknowledge Futurum- the Academy for Healthcare, County Council,

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**13** 

*USA* 

G.S. Kerr1 et al.\*

**Association of Cardiovascular Disease with the** 

Despite the therapeutic advances in RA that have led to reduced pain, joint destruction and disability, as many as 50% of patients are at risk of death from a cardiovascular event (Maradit-Kremers et al., 2005; Stevens et al., 2005). Inexplicable by the usual traditional risk factors, the accelerated atherosclerosis (Gaonzalez-Gay et al., 2005) has been postulated to result from the increased systemic inflammatory burden of rheumatoid disease (Del Rincon

The metabolic syndrome (MetS) is a composite diagnosis, combining phenotypic features that portend an increased risk for cardiovascular disease (CVD). The syndrome consists of visceral obesity, atherogenic dyslipidemia, hypertension, and impaired fasting glucose/glucose tolerance test or overt diabetes mellitus (DM) (National Cholesterol Education Program, 2001). Studies have reported the presence of MetS to be associated with an approximate 2- fold increased risk for incident cardiovascular morbidity and mortality (Lakka et al., 2002), a 2.1 fold increase for initial stroke (Najarian et al., 2006), and 3.5 fold increased risk for Type II DM (Lorenzo et al., 2003). The complex interplay of genetic and environmental factors, insulin resistance and inflammation, are all believed to contribute to

The overall prevalence of MetS in the US population, as evaluated by the National Health and Nutrition Examination Survey (NHANES III), is 23.1%, and increases with age to as high as 44% in those 65 years or older (Ford et al., 2002). Several studies have established an increased prevalence of insulin resistance and increased risk for CVD in RA patients (Dessein et al., 2002a, 2002b). However, there are few reports regarding MetS in RA, and the

\* I. Sabahi1, J.S. Richards1, T.R. Mikuls2, B.V. Rangan3, A. Reimold3, G.W. Cannon4,

*3Dallas Veterans Affairs and University of Texas Southwestern, Dallas, TX, USA 4George E. Wahlen Veterans Affairs and University of Utah, Salt Lake City, UT, USA 5Jackson Veterans Affairs and University of Mississippi, Jackson, MS, USA* 

*2Omaha Veterans Affairs and University of Omaha, Omaha, NE, USA* 

*6Denver Veterans Affairs and University of Colorado, Denver, CO, USA* 

et al., 2001; Gabriel et al., 1999; Kremers & Gabriel, 2006; McEntegart et al., 2001).

**1. Introduction** 

the pathogenesis of the syndrome.

D. Johnson5 and L. Caplan6

**Metabolic Syndrome in a Predominantly Male** 

**Cohort with Rheumatoid Arthritis** 

*1Washington DC Veterans Affairs Medical Center and Georgetown University, Washington, DC* 

