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Combo Therapy Slashes Heart Risk in RA

TNF-Inhibitors and Methotrexate Cut Heart Attack Risk for People With Rheumatoid Arthritis
WebMD Health News
Reviewed by Louise Chang, MD

Nov. 9, 2007 (Boston) -- Combination therapy including TNF-inhibitors along with an older drug known as methotrexate can slash the risk of heart attack in people with rheumatoid arthritis (RA).

People with rheumatoid arthritis who receive TNF inhibitors plus methotrexate have an 80% lower risk of having a heart attack than their counterparts who only take methotrexate, according to research presented at the American College of Rheumatology Annual Scientific Meeting in Boston.

Affecting about 2.1 million Americans, mainly women, rheumatoid arthritis is an autoimmune disease that occurs when the body mistakenly attacks its own joints, causing pain, stiffness, swelling, and problems with mobility. It is also a systemic disease, which means that it can affect other areas of the body as well. People with rheumatoid arthritis are known to be at an increased risk for heart disease due to the systemic effects of inflammation.

"We think this [combination therapy] normalizes their risk to that of people without RA in the general population," says researcher Gurkirpal Singh, MD, adjunct professor of medicine at Stanford University School of Medicine in Palo Alto, Calif. "We need to do this for our patients to save their lives, not just improve their quality of life [by improving joint pain and stiffness]."

Protecting the Heart

Researchers analyzed data from MediCal, California's Medicaid program, on 19,233 people with RA who were treated with TNF-inhibitors, methotrexate, or other disease-modifying anti-rheumatic drugs (DMARDs). The mostly female patients were 55 years old on average and were followed from January 1999 through June 2005. Many were also taking aspirin, which is also known to lower the risk of heart disease.

During the study period, 441 people had heart attacks and 8% were fatal. People with rheumatoid arthritis taking a combination of TNF-inhibitors with methotrexate treatment had a heart attack risk that was 80% less than that of patients taking methotrexate alone. The results took into account factors such as smoking history, aspirin use, and abnormal cholesterol levels.

There was no difference in heart attack risk among those patients who were taking TNF-inhibitors alone, TNF-inhibitors with other DMARDs, other DMARD therapies without methotrexate, or a combination of DMARDs and methotrexate.

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