Rheumatoid arthritis

DMARDs may reverse adverse cardiac changes seen in RA patients


Patients with early rheumatoid arthritis have signs of cardiovascular changes that improve when treated with DMARDs, UK research shows.

Results from the first randomised controlled trial to look at cardiovascular abnormalities in newly diagnosed RA patients with no known cardiovascular disease provide support for the concept that DMARD therapy may have effects beyond those on systemic inflammation, say clinicians from Leeds University.

Writing in the Annals of Rheumatic Diseases, they said the findings had wider implications on personalising treatment in patients to target both joints and cardiovascular risk.

Clinicians may also want to bear the data in mind when considering tapering DMARD treatment, they concluded.

In the study, 81 patients with new onset RA and a maximum of one “traditional” cardiovascular risk factor with the exclusion of diabetes were recruited. They either received etanercept plus methotrexate or methotrexate monotherapy for the first six months.

Scans showed that compared with controls, patients with early RA showed signs suggestive of cardiovascular changes including increased vascular stiffness and evidence of diffuse myocardial fibrosis.

The type of DMARD (first-line TNF-inhibitors or methotrexate) and clinical response to therapy did not affect cardiovascular disease markers. Both DMARD treatment strategies used in the study led to improved vascular stiffness at one and two year follow ups.

Response to treatment or cumulative disease activity were not associated with any further improvement on the vascular changes and neither did the addition of etanercept boost the effect further, they found.

The team from the Universities of Leeds and Manchester concluded that the data “imply benefits of therapy beyond suppression of systemic inflammation, likely suggesting cardiometabolic changes and targeted effects on key immune mediators of CVD”.

Their findings suggest that it may be possible for treatment to be “personalised in stratified patients with RA to not only improve joint specific outcome, but also CVD”, they added.

“This study demonstrated the presence of CV abnormalities at the earliest stage of RA and the ability of RA therapy to improve vascular stiffness.

“These data have wider implications on RA management strategies including DMARD tapering. While this study was not designed to address this, by demonstrating improvement in CV markers, and until further data are available, this should be considered if contemplating drug tapering,” they concluded.

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