Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory, autoimmune disease for which there is no known cure. It affects approximately 2.1 million Americans.
While a cure does not exist, it is possible to put RA into remission.
RA- particularly when not optimally controlled- is a known risk factor for early atherosclerosis (hardening of the arteries) which leads to stroke and heart attacks occurring in patients at least ten years earlier than in people without the disease.
However, earlier studies have suggested that treating rheumatoid arthritis with disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate, and newer biologic therapies may reduce this risk.
A new research study appears to bolster these earlier findings. Between January 2005 and October 2006, the QUEST-RA project (The Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis Program) included 4,363 patients from 48 sites in 15 countries; 78% were female, more than 90% were Caucasian, and the mean age was 57 years.
The scientists were particularly interested in looking at a number of variables that might correlate with the use of methotrexate, the standard DMARD used by most rheumatologists.
Antonio Naranjo and colleagues found that lower risk for cardiovascular events, when adjusted for age, sex, disease activity, and traditional risk factors such as lack of exercise, smoking, diabetes, and high cholesterol levels, correlated strongly with the use of drugs to treat rheumatoid arthritis.
Methotrexate use- evaluated for a period of only one year- was found to be associated with an 18% reduction in risk of heart attack and an 11% decrease in risk of stroke, the researchers noted.
"Our study provides further support of the influence of both traditional and RA specific risk factors in the development of cardiovascular events, especially heart attack" the researchers concluded.
They also found that other DMARDS such as sulfasalazine, glucocorticoids, leflunomide and TNF-inhibitors also conferred lower risk of cardiovascular events.
These findings in such a large group of patients involving centers from around the world lends credence to previous observations. First, rheumatoid arthritis is not a benign condition. This is an issue that must be emphasized to all patients with the disease. Most people are not aware of the long-term complications associated with rheumatoid arthritis. Second, achievement of remission should be a primary goal, ie., it is imperative that patients with rheumatoid arthritis be treated aggressively.
In addition to the important immediate concerns regarding symptoms and potential disability related to deformity, there are other important issues as well.
The marked increased incidence of early cardiovascular events and the development of lymphoma, both of which appear to be related to the chronic unsuppressed inflammatory state experienced by patients with less than optimally controlled RA, demonstrate the need for tighter disease management.
Future studies will, in all likelihood, continue to support the notion of remission in RA as being the goal to achieve.
At the same time, it must be recognized that there are potential side effects associated with all these therapies and that risks as well as benefits should be discussed frankly and openly. An experienced and well-trained rheumatologist should be consulted as soon as possible.
(Naranjo A, et al. Arthritis Research and Therapy. Volume 59; March 2008)
