Dr. Ceponis says it’s likely the TNF inhibitors are keeping patients out of the hospital in part because of their positive effect on the cardiovascular system. “Any chronic inflammation, including RA, is associated with damage to blood vessels in the long term,” Dr. Ceponis says. “Recently studies have started popping up that not only methotrexate, but also TNF inhibitors can reverse increased risk of cardiovascular disease in RA patients. Since RA is a systemic disease, the mechanism of this has likely to do with overall reduction of the chronic inflammatory burden – which in the long term translates into better cardiovascular health.” 

The study raises the question of whether more RA patients should be treated with TNF inhibitors.

“Introduction of TNF inhibitors was the biggest breakthrough in the RA field since widespread introduction of methotrexate,” Dr. Ceponis says. “We now have an additional, powerful tool for the management of RA. But does that mean everybody needs this tool? No.”

Dr. Ceponis says that for most of his patients, traditional DMARDs such as methotrexate will remain first-line therapy. “Three to six months down the line we usually get a good idea whether this will be sufficient,” he says. “If not, we add a TNF inhibitor.”

The authors of the Irish study acknowledge that factors other than TNF inhibitor usage, including use of traditional DMARDs and better management of complications, may have contributed to “improved patient outcomes.”

But Dr. Ceponis says that despite some flaws, the study highlights an important pharmaceutical advancement. “Without overestimation, most rheumatologists believe that TNF inhibitors have made a revolution in what we do in the field,” he says. “With proper use, we can probably change the natural history and progression of the disease not only in the joints, but also in the whole body. The results of this study lend some support for that.”