Background Studies in RA show that a high rate of inflammation correlates with low serum lipids and after intensive treatment to reduce the proinflammatory state, lipids tend to increase (1), being only increased triglyceride levels which were significantly associated with the presence of CVD (2). In patients with early-stage RA, inflammatory markers are elevated and lipids affect both quantitatively (usually decreased) and qualitatively (subfractions are altered (3). Navarro-Millán (4) showed that the use of methotrexate (mtx) for 24 weeks increased lipid levels, although its use is associated with a trend towards reduction of CVD and that is why it has been suggested that presents cardioprotective properties and producing no effect on the characteristics of lipids (5)
Objectives To assess the influence of mtx use in cholesterol (col), triglycerides (Tg) and hemoglobin (Hb) levels, in a cohort of patients with recent-onset RA for 5 year follow-up and record the presence or absence of CVD.
Methods Longitudinal observational study that included 50 patients diagnosed with RA (ACR criteria/EULAR 2010) of less than 6 months from the onset of symptoms and who had started treatment with mtx or hydroxychloroquine (hcq). The presence or absence of CVD baseline was recorded and performed analytical control (no treatment), at one and five years of follow up. Clinical activity as DAS28 (ESR) and Hb levels, Col ang Tg after initiation of treatment was compared in both groups (mtx or hqc).
Results 72% were women with a mean age of 50.39±16.13 years and an average duration of disease less than six months. 64% started treatment with mtx with an average dose of 9.08±1.89 mg/week. The proportion of smoking, hypertension and diabetes was low, although the inflammatory burden was high with an average DAS28>4. The mean total and basal Tg and Col levels was 199.18±37.48 mg/dl and 95.60±46,65mg/dl respectively, both being within normal limits, as well as the mean Hb levels (12.54±1.81 g/dl). During follow any CVD was not described in any of the groups. When comparing the change in the levels of Col and Hb at one and five years compared to baseline in both groups, no significant differences were found, maintaining stable serum levels before and after the introduction of treatment; we found reduced levels of TG in mtx- group at one year follow-up (p<0.05). We also observed a significant reduction in clinical activity as DAS28 when compared with baseline, on a similar way in both groups. (p<0.01).
Conclusions We could conclude that the introduction of mtx in patients with recent-onset RA improves clinical activity and the underlying inflammation without an increase in the levels of total Col or EVC development. There is a decrease in Tg levels significantly when compared with the use of hcq, which corroborate its cardioprotective profile.
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Disclosure of Interest None declared