Data indicates aggressive arthritis treatment to prevent heart events
Further understanding of the coronary events and atherosclerotic disease seen in patients with rheumatoid arthritis has been revealed by drug treatment studies, which were presented at the annual European
congress of rheumatology in Berlin last week.
Researchers in Canada analysed data from two large health insurance databases.
Patients with rheumatoid arthritis and using disease-modifying anti-rheumatic
drugs (DMARDs, including methotrexate, leflunomide and cytokine inhibitors)
appeared to have a 40 per cent lower risk of acute myocardial infarction
(rate ratio 0.6, 95 per cent confidence interval 0.4–1,0) than
those who were not using these drugs. The analysis also found that patients
using selective cyclo-oxygenase-2 inhibitors had a 70 per cent higher
risk of acute MI compared with non-users (rate ratio 1.7, 95 per cent
confidence interval 1.1–2.6). No significant effect on risk was
found with the use of glucocorticoids or traditional non-steroidal anti-inflammatory
drugs.
Presenting the study at the congress, Samy Suissa, professor of epidemiology,
biostatistics and medicine, McGill University Health Centre, Montreal,
said that the analysis provides some suggestions on the best treatments
to avoid the cardiac complications of rheumatoid arthritis.
A second study, conducted in the US, used postal and internet surveys
to identify patients with rheumatoid arthritis who had reported an MI.
Analyses were performed taking into account age, sex, ethnicity, smoking
and the presence of comorbidities (eg, hypertension and diabetes). The
researchers found that if prednisolone was used, the short term (six-month)
risk of MI could be predicted. The hazard ratio was calculated as 1.7
(95 per cent confidence interval 1.1 to 2.6, P=0.021). In contrast, the
analyses found that use of DMARDs or cytokine inhibitors, or both, did
not increase the short-term risk of MI, but neither was a beneficial
effect observed.
In another presentation it was suggested that systemic inflammation seen
in rheumatoid arthritis may also result in more extensive plaque formation
and larger infarct sizes. Gurkirpal Singh, Stanford University School
of Medicine, California, said that the cardiovascular risks attributable
to rheumatoid arthritis have been under-recognised. Improved screening
and preventive measures (eg, use of low-dose aspirin) and aggressive
therapy are needed, he said.
A report of the congress will be published in The Journal next week. |
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