Treatment of Cardiovascular Disease in Rheumatoid Arthritis: A Complex Challenge with Increased Atherosclerotic Risk

Abstract

Rheumatoid arthritis (RA) carries significant risk for atherosclerotic cardiovascular disease (ASCVD). Traditional ASCVD risk factors fail to account for this accelerated atherosclerosis. Shared inflammatory pathways are fundamental in the pathogenesis of both diseases. Considering the impact of RA in increasing cardiovascular morbidity and mortality, the characterization of therapies encompassing both RA and ASCVD management merit high priority. Despite little progress, several drugs discussed here promote remission and or lower rheumatoid disease activity while simultaneously conferring some level of atheroprotection. Methotrexate, a widely used disease-modifying drug used in RA, is associated with significant reduction in cardiovascular adverse events. MTX promotes cholesterol efflux from macrophages, upregulates free radical scavenging and improves endothelial function. Likewise, the sulfonamide drug sulfasalazine positively impacts the lipid profile by increasing HDL-C, and its use in RA has been correlated with reduced risk of myocardial infraction. In the biologic class, inhibitors of TNF-α and IL-6 contribute to improvements in endothelial function and promote anti-atherogenic properties of HDL-C, respectively. The immunosuppressant hydroxychloroquine positively affects insulin sensitization and the lipid profile. While no individual therapy has elicited optimal atheroprotection, further investigation of combination therapies are ongoing.

Analiza przebiegu hospitalizacji pacjentów chorych na reumatoidalne zapalenie stawów w warunkach codziennej praktyki klinicznej

“…The present study confirms the common occurrence of multimorbidity among RA patients, especially the occurrence of cardiovascular disease [17]. Despite better treatment of both RA and cardiovascular disease, this group of diseases constitutes a factor significantly limiting the full recovery and has a markedly negative impact on the quality of life of these patients [18][19][20][21]. In view of the age structure of RA patients and the duration of the disease, it could be speculated that a significant proportion of cardiovascular complications were developed as a consequence of the ineffective treatment of RA before formal inclusion in the treatment programme.…”

Sulfonylureas or biguanides is associated with a lower risk of rheumatoid arthritis in patients with diabetes: A nationwide cohort study

“…The risk of development of RA, stratified by the usage of different anti-DM medications, was summarized in Table 2 . The risk of RA development in non-sulfonylureas or biguanides users among the DM group in each analysis was set as a reference, and the adjusted hazard ratio ( 31 ) of RA in DM patients who were using sulfonylureas or biguanides was 0.73 [95% confidence interval ( 29 ) 0.60–0.90]. The hazard ratio was adjusted for age, sex urbanization, income, length of hospital stays, comorbidities, and use of other anti-glycemic agents.…”

“…After the enrollment of DM, we identified subsequent occurrence of RA in DM patients by using the corresponding international classification of diseases, ninth revision, clinical modification (ICD-9-CM), and the exact ICD-9 coding will be provided upon requested. Most RA diagnoses were confirmed using a catastrophic illness certification (CIC) according to the NHI program regulations ( 29 ). The application of CIC for RA required a strict review process consisting of two rheumatologists, namely, one application rheumatologist and one anonymous senior rheumatologist as an adjudicator.…”

“…The similarities between RA ( 24 , 25 ) and DM ( 26 , 27 ) are profound ( 22 , 23 ). They have similar diverse immune marker involvement ( 7 , 28 ) and the profound comorbidity of cardiovascular disease ( 29 ). The treatment of DM with sulfonylureas or biguanides can improve mortality in autoimmune diseases ( 27 ), and antioxidant medication has the potential to have a protective effect on DM mice ( 30 ).…”

“…provided upon requested. Most RA diagnoses were confirmed using a catastrophic illness certification (CIC) according to the NHI program regulations(29). The application of CIC for RA required…”