Lipid paradox in rheumatoid arthritis: changes with rheumatoid arthritis therapies

Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality, related not only to traditional CV risk factors, but also to a chronic inflammatory state. However, lipid profiles in RA are different from those observed in the general population at risk of CV disease, where there is evidence of a positive relationship between disease and high cholesterol levels. In untreated patients with active RA this relationship is different, with a paradoxical effect resulting in lower levels of cholesterol associated with an increased risk of CV disease. In this review, we summarize the latest evidence on lipid abnormalities in the setting of RA and the interaction between inflammation and lipoproteins, as well as the effect of DMARDs and biologic therapies on lipid profiles and the possible implications for CV outcomes in this population.