Background The risk of cardiovascular disease (CVD) is increased in patients (pts) with rheumatoid arthritis (RA). Systemic inflammation and therapy influence the risk of CVD. Immunosuppressive medications may demonstrate both positive and negative effect on the risk CVD in RA pts.
Objectives To determine the effect of MTX monotherapy, combination MTX with glucocorticiods (GCs) and GCs monotherapy on the frequency of risk factors, subclinical and clinical manifestations of CVD and their complications in RA pts.
Methods We included 136 pts with RA: 86% - female, 14% - male; the median age was 49 [35;56] years; the duration of disease 96 [27;204] months; DAS28 4,6 [3;6,3]. Fifty-three (39%) pts received methotrexate (MTX), 45 (33%) - combination MTX with GCs (MTX+GC), 38 (28%) - oral GCs monotherapy (GC). There were no differences between age, disease duration, DAS 28 in pts treated with various drugs. Traditional risk factors, carotid atherosclerosis and CVD frequency (myocardial infarction, stroke, angina pectoris) were evaluated. Logistic regression model was assessed to determine the risk of CVD in RA pts.
Results Dyslipidemia was detected significantly less in RA pts treated with MTX (25/53 (47%)) as compared to pts with GC monotherapy (25/38 (65%), p=0,049). Concentrations of HDL cholesterol in the serum of pts treated with MTX (1,8 [0,9; 2,0]mmol/l) was higher, than pts with MTX+GC (1,3 [1,1; 1,5]mmol/l, p=0,03) and pts with GC (1,2 [1,0; 1,6]mmol/l, p=0,047). There were no differences in concentrations of other lipids. Incidence of other traditional risk factors like smoking, family history of CVD, hypertension, obesity, metabolic syndrome, diabetes mellitus was the same in different groups of pts. Carotid artery atherosclerotic plaques were detected in 15%,19% and 16%, thickening of the intima-media thickness - in 45%, 53% and 56% of pts treated MTX, MTX+GC,GC, respectively. We found myocardial infarction in 1,6%, 4% and 4,8% cases; stroke - 3,9%, 4%, 4,6%; angina pectoris - 10%, 14%, 13% of pts treated MT, MT+GC, GC, respectively. Combination MTX+GC and GC monotherapy showed an increase in risk of cardiovascular events as opposed to MTX monotherapy (OR 1,3; 95% CI 1,1-1,9; OR 1,9; 95% CI 1,2-2,5, respectively).
Conclusions MTX monotherapy demonstrated advantage in risk of CVD unlike MTX combination with GC and GC monotherapy.
Disclosure of Interest None declared