Background Rheumatologists need to develop primary prevention strategies for cardiovascular disease (CVD) in rheumatoid arthritis (RA) patients. We reported tofacitinib (Tofa) improved arterial stiffness in RA patients. RA is associated with an increased left ventricular mass index (LVMI), a strong marker of cardiovascular mortality.There is no evidence that Tofa effects on left ventricular (LV) morphology and function.

Objectives To study the effect of Tofa plus methotrexate (MTX) on LV morphology and function in MTX resistant active RA patients, in a cohort study design.

Methods RA patients were eligible if they had active disease despite treatment with MTX. All patients have no steroids, and no previous history of CVD. Consecutive 28 patients with moderate to severe active RA patients (DAS28>3.2) despite MTX were received Tofa plus MTX. LV morphology and function was assessed with cardio-MRI at baseline and 24 weeks follow-up. Cardiovascular risk factors and clinical data were collected at regular visits.

Results 24 patients completed 24 weeks. Left ventricular mass index (LVMI) was attenuated significantly by Tofa (week 0-week24, −12.4±5.4 g/m²; p=0.0002). Cardiac output (CO) was attenuated significantly by Tofa (week 0-week24,-0.87±1.2l/min). DAS28 and CRP improved significantly by Tofa (week 0-week24; DAS28: -2.26±0.91; CRP: 14.1±8.7 mg/l) (p<0.05). Surprisingly, the change of disease activity (DAS 28 and CRP) is no correlation with the change of LVMI or CO in this study. Observationally, 4 cases significantly improved right ventricular mass as well as left ventricular mass (20% improved right ventricular mass index from baseline).

Conclusions Tofa improved LVMI and CO in active RA despite MTX. TCZ improves LVMI and CO independently of its effects on disease activity. Tofa might be improved right ventricular mass. JAK-STAT pathway might be an important role of LV hypertrophy. Tofa, JAK-STAT pathway blocking, may prevent cardiovascular morbidity and mortality in RA.

References

1. Tocilizumab monotherapy reduces arterial stiffness as effectively as etanercept or adalimumab monotherapy in rheumatoid arthritis: an open-label randomized controlled trial. Kume K, et al.J Rheumatol. 2011 Oct;38(10):2169–71. doi: 10.3899/jrheum.110340. Epub 2011 Aug 1.PMID: 21807781.

2. Etanercept normalises left ventricular mass in patients with rheumatoid arthritis. Claire Immediato Daïen et al. Annals of the rheumatic diseases. 2013 Jun; 72(6); 881–7. doi: 10.1136/annrheumdis-2012–201489.

References

Acknowledgements Thanks for Noriko Kuwaba to calculate data.

Disclosure of Interest None declared