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Rheumatoid Arthritis (RA) and Spondylo-Enthesitis-related Arthritis (SpA) are systemic chronic flogistic diseases which in their natural history led to progressive damage and articular deformity, with worsening of quality of life, reduced articular functionality and patients’ inability to work [1-5]. In the last two decades, the therapeutic paradigm has deeply shifted. Indeed, it has been demonstrated that early treatment with synthetic Disease Modifying Antirheumatic Drugs (sDMARD), in monotherapy or combined, followed by the use of biological drugs (bDMARD) when the clinical response is inadequate, is associated with a notably better clinical and functional outcome [68]. Epidemiological studies have highlighted that Rheumatoid Arthritis reduces life expectancy by around 10-15 years and that cardiovascular events, above all myocardial infarction and heart failure, represent the leading cause of deaths (around half) [9-12]. Autoptic studies on Rheumatoid Arthritis patients, performed before biological drugs were available, had shown the presence of cardiovascular pathologies in around 60 % of the patients [13,14]. The prevalence of cardiovascular events in Rheumatoid Arthritis patients was similar to that observed in type II diabetes patients [15-18]. The high prevalence of cardiovascular pathology in patients affected with Chronic Arthritis is probably due to both the increase of traditional risk factors for atherosclerosis and the presence of a chronic flogistic state that induces an acceleration of the atherosclerosis process [19-21]. In physiological conditions, the vascular endothelium is involved in maintaining antithrombotic and anticoagulant homeostasis. In a flogistic state the endothelium becomes a target for cytokines, autoantibodies, and immune complexes; as a result, pro-atherogenic and pro-thrombotic modifications take place [22]. In particular, during Chronic Arthritis, the release of proinflammatory cytokines (TNF-α, IL-1 and IL-6) produced in the synovial tissue seems to induce dyslipidemia, insulin resistance, and proatherogenic modifications in the vascular endothelium [23]. Indeed, hyperinsulinemia, insulin resistance and reduction in glucose tolerance have been observed in patients affected with Rheumatoid Arthritis, with a correlation to the severity of flogosis [24,25]. An effective drug treatment on flogosis and disease activity could be expected to reduce cardiovascular risk in patients affected with Chronic arthritis and, actually, Rheumatoid arthritis patients treated with methotrexate had shown a reduced mortality due to cardiovascular events, but not due to other causes [26].

Chronic Inflammatory Arthritis: Patient Management in the Outpatient Units of the Italy Piedmont Region: Focus on Cardio- and Cerebro-vascular Events