Combo Therapy Slashes Heart Risk in RA
TNF-Inhibitors and Methotrexate Cut Heart Attack Risk for People With Rheumatoid Arthritis
WebMD News Archive
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
"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
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
"It's the same inflammation we see in the joint lining that also occurs
in the lining of the blood vessels, and this may led to a propensity for
cardiac complications," says Singh. "Treatments that reduce
inflammation in a powerful fashion may have beneficial effects on the
Eric Ruderman, MD, a rheumatologist at Northwestern Medical Faculty
Foundation Inc. in Chicago, tells WebMD that the new findings make good
"My suspicion is that it's not about any individual therapy or
therapies," he says. "Heart disease is an inherent comorbidity of RA
and we would like to think that any therapy that aggressively treats RA in the
joints and has systemic effects will have an effect on heart risk," he
The new findings provide "all the more reason to treat people more
aggressively and control the disease," he says.