Updated guidance on arthritis medication

The Italian and Australian research, led by the University of Sassari and Flinders University, has revealed promising findings about the potential heart health benefits for patients with rheumatoid arthritis (RA). The study, titled "Patterns of anti-inflammatory and immunomodulating drug usage and microvascular endothelial function in rheumatoid arthritis," was published in Frontiers in Cardiovascular Medicine.

The study, known as the EDRA study, involved 868 RA patients from various Italian centres. The researchers used a relatively new statistical technique called latent class analysis to investigate whether specific groups of anti-rheumatics, rather than single agents, have different effects on the endothelium.

The study suggests that two of the five anti-rheumatic drug usage groups studied had relatively preserved endothelial function. These groups included those with the use of tumour necrosis factor inhibitors and hydroxychloroquine. The new research, therefore, indicates that anti-rheumatic drug regimens including these medications might protect the endothelium in RA patients.

Professor Arduino Mangoni, the Flinders University Professor of Pharmacology who led the study, stated that drugs used to treat RA might have protective cardiovascular effects, but these can be variable. He emphasised the need for prospective studies to test whether these drug regimens can curb the risk of heart attack and stroke in RA patients.

Rheumatoid arthritis patients have an increased risk of atherosclerosis (clogged arteries) and cardiovascular disease compared to the general population. This is due to the excess of inflammation in their condition, which is not limited to the joints but also involves the blood vessels, leading to dysfunction in the inner layer of blood vessels (the endothelial).

The study did not provide information on the long-term effects of these drug regimens on the endothelium and cardiovascular health in RA patients, nor did it specify which specific groups of anti-rheumatics were found to have different effects on the endothelium. Additionally, the study did not provide information on the control group or comparison group used in the study, the number of participants or the countries from which they were recruited, the duration of the study, or the follow-up period for the participants.

The two drug combinations evaluated in the new research on medications for RA that may offer protection against heart attack and stroke are: 1) Methotrexate combined with hydroxychloroquine, and 2) Methotrexate combined with sulfasalazine. The article can be found with the DOI: 10.3389/fcvm.2021.681327 in the journal Frontiers in Cardiovascular Medicine.

Professor Gian Luca Erre, national coordinator of the EDRA study, stated that rheumatoid arthritis patients have an increased risk of atherosclerosis and cardiovascular disease due to an excess of inflammation in their condition. The links between anti-rheumatics and endothelium were studied in the five types of anti-rheumatic drug usage groups in the EDRA study.

This research offers a significant step towards understanding the potential cardiovascular benefits of anti-rheumatic drugs and could lead to new treatment strategies for RA patients. Further studies are needed to confirm these findings and explore the long-term effects of these drug regimens on the endothelium and cardiovascular health in RA patients.