RA increases patients risk of heart disease, according to new study

According to an article found at News Medical, Rheumatoid arthritis (RA) sufferers are at an increased risk of dying due to cardiovascular disease. A new five year study published in BioMed Central’s open access journal Arthritis Research & Therapy showed that the risk of cardiovascular disease for people with RA is due to disease-related inflammation as well as the risk factors, which affect the general population. Treatment of arthritis with disease modifying anti-rheumatic drugs (DMARDs) also reduced the patient’s risk of heart disease.

RA is a chronic, systemic inflammatory disorder that may affect many tissues and organs but principally attacks the joints producing an inflammatory synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joints. Rheumatoid arthritis can also produce diffuse inflammation in the lungs, pericardium, pleura and sclera, and also nodular lesions, most common in subcutaneous tissue under the skin. Although the cause of rheumatoid arthritis is unknown, autoimmunity plays a pivotal role in its chronicity and progression.

There are a variety of arthritis medications called disease-modifying anti-rheumatic drugs, or DMARDs, that work by curbing the underlying processes that cause certain forms of inflammatory arthritis including rheumatoid arthritis (RA), ankylosing spondylitis, and psoriatic arthritis.

These drugs not only treat arthritis symptoms, but they also can slow down progressive joint destruction. Some of these medications have been used to treat other conditions, such as cancer or inflammatory bowel disease or to reduce the risk of rejection of a transplanted organ.

 

Common DMARDs include: Hydroxychloroquine (Plaquenil), Leflunomide (Arava), Cyclosporine (Neoral), Sulfasalzine (Azulfidine), Gold (Ridaura, Solganal, Myochrysine), Methotrexate (Rheumatrex, Trexall), Azathioprine (Imuran), Cyclophosphamide (Cytoxan), Biologics (Actemra, Cimzia, Enbrel, Humira, Kineret, Orencia, Remicade, Rituxan, Simponi).

For this new study, over 400 people with RA were followed from date of diagnosis for five years. Progression of their disease was measured using chemical markers of inflammation and physical appearance. Treatment regimes were monitored along with risk factors for heart disease, including weight, cholesterol levels, blood pressure, diabetes and smoking.

After five years, 97% of the patients had been treated with DMARDs, reducing both the chemical markers of inflammation and the physical appearance of their arthritis. Patients were also looking after themselves better – fewer patients were smokers and their BMI, and blood pressure had reduced (due in part to treatment for high blood pressure).

Analysis of the patient data revealed that a new cardiovascular event such as heart disease, stroke or DVT could be predicted by intensity of their arthritis and by presence of diabetes, high blood pressure, and the level of triglycerides. Encouragingly treatment with DMARDs decreased the risk but COX-2 inhibitors appeared to predict a new event.

Dr. Wållberg-Jonsson from University Hospital, Umeå, in Sweden said, “Inflammation associated with rheumatoid arthritis increases patients risk of heart disease and other cardiovascular events. However, it is possible to reduce this risk in a two-pronged attack by treating both the inflammation and traditional risk factors for heart disease.”

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