More than 1.3 million adults in the United
States have rheumatoid arthritis, a chronic autoimmune and inflammatory disease
that causes painful joint swelling. It’s known that inflammation leads to
atherosclerosis and contributes to heart disease, which may explain the
elevated rates of heart disease in people with rheumatoid arthritis.
People with rheumatoid arthritis have a
greater than average risk of cardiovascular disease, but a new study suggests
that drugs commonly used to reduce joint inflammation in patients also reduce
that risk.
“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.
Recent clinical trials have shown that
immunomodulators-drugs that decrease inflammation-significantly reduce heart
attacks, strokes, and other cardiovascular events in people with cardiovascular
disease. But it was not clear if these drugs have a similar effect on people
with rheumatoid arthritis, who have a 50% higher risk of heart disease than the
average person.
Methotrexate is the first treatment choice for
patients with moderate to severe rheumatoid arthritis, but most RA patients
will go on a tumor necrosis factor inhibitor (TNFi) or triple therapy
(methotrexate plus sulfasalazine and hydroxychloroquine) at some point.
In the new study, led by researchers at
Columbia University and Brigham and Women’s Hospital, 115 adults with moderate
to severe rheumatoid arthritis despite treatment with methotrexate were
randomized to add a TNFi-either adalimumab (Humira) or etanercept (Enbrel)-or
to go on triple therapy. After six months, both groups had similar reductions
in arterial inflammation, a proxy for heart disease risk, and RA disease
activity.
“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.”
Reference:
Joan Bathon et al, Reducing cardiovascular risk
with immunomodulators: a randomized active comparator trial among patients with
rheumatoid arthritis, Annals of the Rheumatic Diseases, DOI 10.1136/ard-2022-223302