Adding a tumour necrosis factor inhibitor (TNFi) or sulfasalazine plus hydroxychloroquine to methotrexate reduces heart disease risk in patients with rheumatoid arthritis (RA), says a new study.

With RA patients about 50 per cent more likely to experience cardiovascular events, 115 patients with active RA despite methotrexate received a TNFi or sulfasalazine plus hydroxychloroquine for 24 weeks. 

At baseline, patients showed similar levels of vascular inflammation. After 24 weeks, both TNFi and sulfasalazine plus hydroxychloroquine added to methotrexate significantly reduced vascular inflammation. No difference emerged between the two treatments, which reduced RA disease activity to a similar extent. 

The reduction in RA disease activity did not correlate with reduced vascular inflammation, which seems to be independent of the benefits on joint disease. 

The improvements in vascular inflammation are “clinically important” and similar to the effect produced by moderate statin doses, says Professor Joan Bathon of Columbia University Vagelos College of Physicians and Surgeons, New York.  

“Doctors still need to pay attention to heart disease risk factors such as high cholesterol, high blood pressure and obesity but since inflammation – a key feature of RA – elevates cardiovascular risk even further, reducing inflammation by treating the arthritis is a novel mechanism to reduce heart disease risk in these patients.” 

Future studies will explore the mechanisms through which anti-inflammatories used in RA reduce vascular inflammation. (Annals of the Rheumatic Diseases DOI: 10.1136/ard-2022-223302)