Arthritis, in particular rheumatoid arthritis (RA), has devastating effects on the body, causing many debilitating effects and leaving many patients immobile or able to function normally. However, there are also some additional effects associated with the disease which are less well known, but just as threatening. A number of studies presented at the Annual European Congress of Rheumatology provide new data on the risks of cardiovascular diseases for RA patients, as well as some of the risks associated with the new therapies in the area, that are just beginning to emerge.
INCREASED HEART ATTACK RISKS IN RA PATIENTS DESPITE CHANGES IN DISEASE MANAGEMENT
Today (Friday 23 June), Dr. Ulf Bergström will present the results of a study showing that, despite changes in the management of rheumatoid arthritis in the last 20 years, there is no significant impact on co-morbidity related to cardiovascular diseases, in particular, related to myocardial infarction (heart attack).
As recognized by the investigators, patients with rheumatoid arthritis (RA) have a shortened lifespan when compared to people with same gender and similar age and recent studies suggest that this is largely due to increased mortality from premature cardiovascular disease, in particular myocardial infarction. As the medical field has gained a better understanding of rheumatoid arthritis, the management of it has changed significantly in terms of medical treatments and physiotherapy.
The study evaluates the effects of the changes in management of RA on the cardiovascular morbidity and mortality in patients with established RA during 1978 to 2002, by analyzing two separate patient studies from 1978 and 1995 (with an 8 year follow-up), and compared to the corresponding background population. The study found no significant changes in the cardiovascular morbidity between the two studies (standardized mortality ratios: 158 (CI: 111-225) and 168 (CI: 118-232) for the 1978 and 1995 cohorts respectively).
“The management of the disease has changed significantly over the decades and this study gives excellent measurement into whether this has had an improvement on cardiovascular events experienced by RA patients”, said Dr. Bergström. “It shows that further action is necessary in order to reduce additional mortality in RA”.
This study also highlights the need for further data on whether newer treatment options, such as TNF inhibitors that were introduced in Europe at the beginning of the millennium and therefore did not have a significant role in this study, will have an effect on cardiovascular events for RA patients in the future.
TNF INHIBITORS REDUCES THE RISK OF SERIOUS CARDIOVASCULAR EVENTS IN RHEUMATOID ARTHRITIS PATIENTS
Dr. William Dixon presented the results of a new study today (Friday 23 June) at the Annual European Congress of Rheumatology in Amsterdam, which shows encouraging data that treatment with TNF inhibitor reduces the risk of Myocardial Infarction (MI) and Cerebrovascular Accidents (CVA) in rheumatoid arthritis (RA) patients, when compared to patients treated with traditional DMARDs.
Recent studies suggest that the excess of deaths in rheumatoid arthritis patients is largely due to increased mortality from premature cardiovascular disease. Dr. Dixon comments, “It is already known that TNF inhibitors reduce the risk of cardiovascular events in RA patients, including less serious events. But this study has suggested that they specifically reduce the risk of myocardial infarction and cerebrovascular accidents, which are two of the most serious cardiovascular events, often leading to death”. He added, “This study shows encouraging results for people with RA which could potentially reduce the mortality amongst these patients.”
TNF inhibitors are a new class of drugs available for the treatment of severe rheumatoid arthritis. The drugs work by blocking the action of TNF (tumour necrosis factor), a molecule responsible for increasing levels of inflammation in people with rheumatoid arthritis. “The reason why the TNF inhibitors have shown to reduce the risk of MI and CVA could be that the events are caused by inflammatory factors, which is reduced by the TNF inhibitors’ anti-inflammatory effects”, said Dr. Dixon.
INCREASED RISK OF SERIOUS INFECTIONS WITH TNF INHIBITOR TREATMENT
Treatment with TNF inhibitors might increase the risk of common serious infections, according to a new study, presented at the Annual European Congress of Rheumatology in Amsterdam by Dr. Johan Askling on Friday (23 June).
As recognized by the investigators of the study, it is already established that TNF inhibitors increases the risk for intracellular infections such as TB. The risk for much more common, yet still serious, infections remains less clear. Studies from clinical practice have shown mixed results, and taken together, clinical trials indicate the possibility for a risk increase of clinical significance.
The infections that were included in the study were respiratory, septicaemia, articular, gastrointestinal, cutaneous, or other infections leading to hospitalisation.
Based on 422 hospitalizations with infection, the study concluded that, if treated with TNF inhibitors, the patients experienced a 20 to 30%-increase in risk of hospitalizations related to infections.
“The reason for this drug-related increase in risk of infections is not yet clear, although our results demonstrate a lower degree of risk increase than what was recently suggested based on trial data. However, since part of the drugs’ very action is to interfere with the body’s normal defense against infections, some degree of risk increase is fully conceivable”, Dr. Askling said. “TNF inhibitors drugs have showed great effectiveness for many patients and is an excellent example that raises the discussion of whether, or when, the benefits the drugs outweighs any risks associated with them”, Dr. Askling added.