Background Life expectancy in rheumatoid arthritis (RA) patients is reduced by 3-10 years mainly due to cardiovascular diseases. In the core study, we found that selected normotensive, non-diabetic, premenopausal RA patients had increased intima media thickness and more plaques, and thereby accelerated atherosclerosis, comparing to controls. In present follow up study we studied the impact of treatment with methotrexate and disease activity on progression of atherosclerosis in the same RA patients in a time span of 5.5 years.
Methods The study group comprised of 22 female RA patients who were treated with methotrexate. RA was diagnosed according to the 1987 revised criteria of the American College of Rheumatology. 46 RA patients not treated with methotrexate were selected as a control group. Ultrasound examination of carotid arteries was performed. Results of intima media thickness (IMT) and plaques were statistically studied and correlated with classical and non-classical risk factors for atherosclerosis as well with cytokines, adhesion molecules, CRP and disease activity score-28 (DAS-28).
Results The IMT in patients treated with methotrexate was 0.63±0,08 mm and 0.64±0,11mm in those untreated (p>0.05). We also calculated the difference in plaque number in patients who were treated with methotrexate and those who were not. We found plaques in 6 patients treated with methotrexate and in 11 untreated patients (p>0.05).We compared DAS-28 in patients who were treated with methotrexate and those who were not. The DAS-28 in patients treated with methotrexate was 4.19±1.71, and the DAS-28 in patients who did not receive methotrexate was 3,84±1.34 (p>0.05).
Conclusions The IMT in study RA patients with severe disease treated with methotrexate had lower values of IMT and fewer atherosclerotic plaques in comparison to RA patients who did not receive methotrexate. However they did not reach a statistically significant difference. The patient number is small and the time span is also relatively short. More patients and a longer treatment time are required for definitive results. It should also be noted that patients with a severe disease are expected to have increased IMT in comparison to those with a less severe disease. Patients with more severe disease in our study group received methotrexate, which obviously delayed IMT progression.
Choi HK, Hernán MA, Seeger JD, Robins JM, Wolfe F. Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet. 2002 Apr 6;359(9313):1173-7.
Wallberg-Jonsson S, Öhman M-L, Rantapää-Dahlquist S. Which factors are related to the presence of atherosclerosis in rheumatoid arthritis. Scand J Rheumatol. 2004; 33:373-9.
Salliot C, van der Heijde D. Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research. Ann Rheum Dis. 2009 Jul;68(7):1100-4.
Turiel M, Tomasoni L, Sitia S, Cicala S, Gianturco L, Ricci C, Atzeni F, De Gennaro Colonna V, Longhi M, Sarzi-Puttini P. Effects of long-term disease-modifying antirheumatic drugs on endothelial function in patients with early rheumatoid arthritis. Cardiovasc Ther. 2010 Oct;28(5):e53-64. doi: 10.1111/j.1755-5922.2009.00119.x.
Disclosure of Interest None declared