In individuals with rheumatoid arthritis, who are at an increased risk for the illness, medicines often administered to patients to reduce joint inflammation may also reduce the risk of cardiovascular disease.
The study, titled, ‘Reducing cardiovascular risk with immunomodulators: a randomised active comparator trial among patients with rheumatoid arthritis’, was published in the journal Annals of Rheumatic Diseases. “The reassuring message is that as your joints are improving with RA treatments, so too is your risk for cardiovascular disease,” says Joan Bathon, MD, a co-leader of the study and professor of medicine and director of the division of rheumatology at Columbia University Vagelos College of Physicians and Surgeons.
Immunomodulators, or anti-inflammatory medications, have been demonstrated in recent clinical studies to considerably lower heart attacks, strokes, and other cardiovascular events in persons with cardiovascular disease. However, it remained unclear if these medications, which increase heart disease risk by 50% compared to the general population in adults with rheumatoid arthritis, have a similar impact on these patients.
Rheumatoid arthritis is a chronic autoimmune and inflammatory disease that causes painful joint swelling and affects more than 1.3 million individuals in the United States. Inflammation is known to cause atherosclerosis and contribute to heart disease, which may account for the higher prevalence of heart disease in rheumatoid arthritis sufferers.
Patients with moderate to severe rheumatoid arthritis should first consider methotrexate, although most RA patients eventually start on a tumour necrosis factor inhibitor (TNFi) or triple therapy (methotrexate plus sulfasalazine and hydroxychloroquine).
In a recent study, conducted by Brigham and Women’s Hospital and Columbia University researchers, 115 adults with moderate to severe rheumatoid arthritis who had not responded to methotrexate treatment were randomised to triple therapy or to add a TNFi, either adalimumab (Humira) or etanercept (Enbrel).
Both groups saw comparable reductions in arterial inflammation, a risk factor for heart disease, and RA disease activity after six months.
“We were surprised to see that both of these powerful anti-inflammatory treatment strategies reduced heart disease risk in patients with rheumatoid arthritis,” Bathon says. “Doctors still need to pay attention to the usual heart disease risk factors, such as high cholesterol, high blood pressure, and obesity. But since inflammation–a key feature of RA–elevates cardiovascular risk even further, reducing inflammation by treating the arthritis is a novel mechanism to reduce heart disease risk in these patients.”