Treatments for rheumatoid arthritis might also help to reduce cardiovascular damage
INTRODUCTION
Rheumatoid arthritis is a chronic inflammatory disease that can affect a person’s joints, and may cause pain and disability. Rheumatoid arthritis affects people of all ages, and is more common in women than men. People with rheumatoid arthritis have an increased risk of suffering from cardiovascular diseases such as heart attacks, heart failure or stroke. This is because the inflammation involved in rheumatoid arthritis can have an effect on other systems in the body, as well as the joints.
WHAT DID THE AUTHORS HOPE TO FIND?
The authors wanted to find out whether people with early rheumatoid arthritis who have no known history of heart disease have any signs of abnormalities in their heart and blood vessels. They especially wanted to see if the medicines that people take for their rheumatoid arthritis improve something called vascular stiffness. This is used as an indicator of heart or cardiovascular disease.
WHO WAS STUDIED?
The study looked at 81 people who had recently been diagnosed with rheumatoid arthritis and had experienced symptoms for only a short time (called early rheumatoid arthritis). None of the people had a known history of heart disease. The people taking part could have only one known traditional risk factor – an aspect that makes it more likely that you will have heart disease. These risk factors were: smoking, high cholesterol, high blood pressure, or being related to someone who had or has heart disease (family history). People with diabetes could not take part, even if that was their only risk factor. This is because the diabetes would make it more difficult to understand the links between rheumatoid arthritis and heart disease.
HOW WAS THE STUDY CONDUCTED?
The study was part of a trial testing the effects of two different treatments for early rheumatoid arthritis. People were split into two groups to receive either a biological medicine or methotrexate. Everyone had an MRI scan to look at their heart at the start of the study and another scan after 1 and 2 years of treatment. The authors also used scans from the hearts of 30 healthy volunteers to compare against.
WHAT WERE THE MAIN FINDINGS OF THE STUDY?
The heart scans revealed that the vascular stiffness of the aorta (the main artery in the body) improved during the study. Also, both treatments for rheumatoid arthritis improved vascular stiffness, regardless of how much the treatment improved people’s arthritis symptoms. This is important, because it suggests that, in addition to suppressing inflammation, treatments for rheumatoid arthritis might influence people’s cardiovascular risk in other ways. This could possibly by changing underlying processes of heart and vascular disease.
ARE THESE FINDINGS NEW?
Yes – this is the first study designed in this way to look at heart scans in a group of people with newly diagnosed rheumatoid arthritis and comparing two different treatments.
WHAT ARE THE LIMITATIONS OF THE STUDY?
The main limitation is that the study used MRI scans to work out the presence of cardiovascular changes – not actual cardiovascular events such as heart attacks. It would need a much bigger and longer study to get enough information about the number of cardiovascular events, which is not feasible. More studies with a longer follow-up with scans would be interesting to tell us more about the changes in people’s blood vessels and heart over time and how these relate to their arthritis and any future cardiovascular disease they might get.
WHAT DO THE AUTHORS PLAN ON DOING WITH THIS INFORMATION?
The authors will continue to monitor the people in the study. They are also doing some work with blood
samples to see if there is any link between people’s genes and the blood vessel and heart changes seen on the MRI scans. This could provide information on new targets for drug treatment.
WHAT DOES THIS MEAN FOR ME?
If you have rheumatoid arthritis, this research highlights the importance of starting treatment early. This will improve traditional joint symptoms, and may also reduce risk of developing cardiovascular disease. More studies will be needed, but this information also suggests that we should be cautious about reducing treatment for rheumatoid arthritis if joint symptoms get better, as there could be more going on under the surface.
If you have any concerns about your disease or its treatment, you should talk to your doctor.
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Date prepared: October 2020
Summary based on research article published on: 28 August 2020
From: Plein S, et al. Cardiovascular effects of biologic versus conventional synthetic disease modifying antirheumatic drug therapy in treatment-naïve, early rheumatoid arthritis. Ann Rheum Dis 2020;79:1414–1422.doi: 10.1136/annrheumdis-2020-217653.
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