A study presented at a meeting of the American College of Rheumatology Annual Scientific in Atlanta might help explain why people with rheumatoid arthritis (RA) tend to have more heart attacks and strokes than the general population. Researchers found that inflammation, a signature of this autoimmune disease, may be contributing to the build-up of plaque in arteries. They also found that certain arthritis drugs might play a role in RA patients’ risk of heart disease.
“One key finding of our study was that RA patients had to have both high levels of inflammation and higher numbers of traditional cardiovascular risk factors, like high blood pressure, diabetes, etc., in order for inflammation to be a risk factor for carotid plaque progression,” explains lead investigator Jon T. Giles, MD, an assistant professor of medicine in the division of rheumatology at Johns Hopkins University in Baltimore.
For this study, researchers gave 158 RA patients two ultrasounds three years apart to assess the thickness of their carotid artery walls.(Two common carotid arteries, one on each side of the neck, branch off into smaller internal and external arteries that deliver blood to the brain and face.) In doing so, they discovered that 82 percent had a thickening of their common carotid artery walls and 70 percent had a thickening in their internal carotid artery walls.
They also found that this risk was reduced with some RA drugs and increased with others. Those on anti-TNF biologic medications at the start of the study had 37 percent less thickening than those not on the drugs. Examples of anti-TNF medications used to treat RA include certolizumab, or Cimzia, etanercept or Enbrel, adalimumab, or Humira, infliximab, or Remicade, golimumab, or Simponi. Prednisone, a corticosteroid, caused more thickness, but that effect was tempered when patients were also given statins to lower cholesterol.
“The good news is we’re just trying to get a handle on the long-term use of TNF blockers: Are they good or bad, aside from the fact that they improve the arthritis symptoms,” says Robert Katz, MD, a rheumatologist at Rush University Medical Center in Chicago and a professor of medicine at Rush Medical College. “It is reassuring to those who want to take those drugs, judging by this study, that it might actually reduce risk for heart attack or stroke.”
He adds, “If you are on prednisone, you should watch your blood pressure, glucose and cholesterol even more closely.”
Researchers also report that plaque build-up, also called atherosclerosis, was higher in patients with the highest number of swollen joints and those with elevated levels of c-reactive protein. C-reactive protein is a marker of inflammation in the body.
Doctors say these findings indicate that reducing inflammation in RA patients could potentially reduce the number of cardiac problems these folks have, but Dr. Giles says future research needs to specifically test these medications to compare their effects on plaque build-up.
“Our study was not interventional, so any conclusions applied to clinical care are only extrapolations,” he says. “However, our data suggest that reducing inflammation, particularly in patients with traditional cardiovascular risk factors, may help reduce the build-up of atherosclerosis that leads to heart attacks and strokes.”