Rheumatic Diseases

The inflammatory nature of atherosclerosis was previously described by the Austrian pathologist Carl von Rokitansky in the 1840s and by Rudolf Virchow somewhat later.1 Although Rokitansky believed that the inflammation was secondary to other disease processes, Virchow promoted atherosclerosis as a primary inflammatory disease. It appears that Virchow had a point. Even in Rokitansky′s own arterial specimens, activated T cells and other inflammatory cells are present at an early stage of disease, which argues for the opinions of Virchow.1 On the other hand, as is demonstrated in the meta-analysis in the present issue of Arteriosclerosis, Thrombosis, and Vascular Biology, rheumatic diseases are associated with increased atherosclerosis.2 Thus, it is plausible that both Rokitansky and Virchow were right, that both possibilities were nonmutually exclusive.See accompanying article on page 1014 It is somewhat surprising that little attention was paid to the inflammatory nature of atherosclerosis in general until the 1980s.3,4 Thus, atherosclerosis is an inflammatory process in large and middle-sized arteries, characterized by infiltration of the intima by activated monocytes/macrophages and T cells.5,6 Proinflammatory cytokines are produced by immune-competent …