Patients with rheumatoid arthritis may be more likely to develop atherosclerosis if they have high levels of inflammation and cardiovascular risk factors.

INTRODUCTION

Rheumatoid arthritis is a chronic inflammatory disease that affects a person’s joints, causing pain and disability. Patients with rheumatoid arthritis often have a higher risk of developing cardiovascular diseases such as coronary heart disease, stroke or heart attack. This may be caused by patients with rheumatoid arthritis being more likely to develop atherosclerosis – a hardening or thickening and narrowing of the arteries that carry blood in the body.

WHAT DID THE AUTHORS HOPE TO FIND?

The authors wanted to see whether the level of inflammation in patients with rheumatoid arthritis is linked to the development of atherosclerosis, and to see if they could identify any particular factors that influence the development of atherosclerosis in these people.

WHO WAS STUDIED?

The study included 566 patients diagnosed with rheumatoid arthritis. These patients were consecutive patients diagnosed with RA, which means that they were included in the order in which they were seen in the clinic, and they were studied regardless of any other variables such as age, gender or the medicine they were taking.

HOW WAS THE STUDY CONDUCTED?

This was a longitudinal follow-up study, which means that the patients were observed over a period of time and measurements taken, but there was no study intervention or medicine being tested. The same measurements were taken when patients entered the study, and again after 3 years.
The authors used ultrasound to measure the thickness of the carotid artery, which can be used to estimate the degree of atherosclerosis present. They also recorded the severity of each person’s rheumatoid arthritis, and took measurements to work out if patients had any cardiovascular risk factors such as hypertension, diabetes or high cholesterol, and whether or not they smoked or were overweight. Inflammation was measured by taking a blood sample and examining each person’s erythrocyte sedimentation rate (ESR) – this is an indirect test that is used to measure how many inflammatory proteins there are by recording the speed at which the red blood cells fall to the bottom of a sample of blood.

WHAT WERE THE MAIN FINDINGS OF THE STUDY?

The study found that, over 3 years, the walls of the artery had thickened by an average of around 10%. The authors found that patients with higher levels of inflammation were more likely to develop atherosclerosis. There was also a link between the marker used to measure inflammation and a number of increased cardiovascular risk factors. Patients who developed atherosclerosis more quickly tended to have a higher number of risk factors. The authors also found that the risk of artery thickening might be reduced in patients receiving methotrexate, or a group of biologic drugs called the anti-TNFs; however, they cannot draw any firm conclusions about this because the study was not designed to look at the effect of medications.

ARE THESE FINDINGS NEW?

Not all of the findings are new. Some of the results confirm those seen in previous studies, but the link between erythrocyte sedimentation rate and cardiovascular risk factors has not been reported before.

HOW RELIABLE ARE THE FINDINGS?

There are some limitations which may affect how reliable the findings are. The study used ultrasound to measure the thickness of artery walls as an indicator of whether there was atherosclerosis present, and this may not be accurate in all patients. To minimise any variation, the same researcher read all the ultrasounds for the patients in the study.
Additionally, there is what is a called a selection bias in the group of patients studied. Only patients with rheumatoid arthritis were included, so there was no control group of healthy people to compare the results to.

WHAT DO THE AUTHORS PLAN ON DOING WITH THIS INFORMATION?

This information will be used to support the idea that inflammation should be reduced as much as possible in patients with rheumatoid arthritis. There may be additional studies to confirm the results.

WHAT DOES THIS MEAN FOR ME?

These results suggest that inflammation should be reduced as much as possible in patients with rheumatoid arthritis in order to protect against the risk of cardiovascular problems. Patients with rheumatoid arthritis are often prescribed anti-inflammatory medicines. These may work to target systemic inflammation, as well as treating the underlying cause of the rheumatoid arthritis. For this reason, patients should always speak to their doctor before they stop taking any medication, even if they feel well. You can take steps to reduce your cardiovascular risk factors, and patients with rheumatoid arthritis should not smoke, and should try to maintain their weight at a healthy level. This will help to minimise the risk of developing cardiovascular diseases such as stroke or heart attack.

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Date summary prepared: June 2015

Summary based on research article published on: 20 May 2014

From: del Rincón, I. et al. Systemic inflammation and cardiovascular risk factors predict rapid progression of atherosclerosis in rheumatoid arthritis. Ann Rheum Dis 2015;74:1118–23. doi:10.1136/annrheumdis- 2013-205058

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