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.
"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 heart."
Eric Ruderman, MD, a rheumatologist at Northwestern Medical Faculty Foundation Inc. in Chicago, tells WebMD that the new findings make good sense.
"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 explains.
The new findings provide "all the more reason to treat people more aggressively and control the disease," he says.