RESEARCH - DMARDs are associated with a reduced risk for cardiovascular disease in patients with RA

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Disease-modifying antirheumatic drugs are associated with a reduced risk for

cardiovascular disease in patients with rheumatoid arthritis - a case

control study

Vokko P van Halm , T Nurmohamed , Jos WR Twisk , Ben AC Dijkmans

and andre E Voskuyl

Arthritis Research & Therapy 2006

Published 20 September 2006

Abstract (provisional)

Rheumatoid arthritis (RA) is characterized by inflammation and an increased

risk for cardiovascular disease (CVD). This study investigates possible

associations between CVD and the use of conventional disease-modifying

antirheumatic drugs (DMARDs) in RA. Using a case control design 613

RA-patients (5649 patient-years) were studied, 72 with CVD and 541 without

CVD. Data on RA, CVD and drug treatment were evaluated from time of

RA-diagnosis up to the first cardiovascular event or the end of the

follow-up period. The dataset was subcategorized according to DMARD-use,

sulfasalazine (SSZ), hydroxychloroquine (HCQ) or methotrexate (MTX). Odds

ratios (ORs) for CVD, corrected for age, gender, smoking and RA-duration,

were calculated per DMARD-group. Patients who never used SSZ, HCQ or MTX

were used as reference group. MTX-treatment was associated with a

significant CVD-risk reduction, ORs (95% CI): 'MTX only' 0.16 (0.04-0.66),

'MTX and SSZ ever' 0.20 (0.08-0.51) and 'MTX, SSZ and HCQ ever' 0.20

(0.08-0.54). The risk reductions remained significant after additional

correction for the presence of rheumatoid factor and erosions. After

correction for hypertension, diabetes and hypercholesterolemia 'MTX or SSZ

ever' and 'MTX, SSZ and HCQ ever' showed significant CVD-risk reduction.

Rheumatoid factor positivity and erosions both increased CVD-risk, ORs: 2.04

(1.02-4.07) and 2.36 (0.92-6.08). MTX and to lesser extend SSZ, were

associated with significantly lower CVD-risk compared to RA-patients who

never used SSZ, HCQ or MTX. We hypothesize that DMARD-use, in particular

MTX-use, results in powerful suppression of inflammation, thereby reducing

the development of atherosclerosis and subsequently overt CVD.

http://arthritis-research.com/content/8/5/R151/abstract

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