Treatment of Cardiovascular Disease in Rheumatoid Arthritis: A Complex Challenge with Increased Atherosclerotic Risk

Area of Science:

• Rheumatology
• Cardiology
• Immunology

Background:

• Rheumatoid arthritis (RA) significantly elevates the risk of atherosclerotic cardiovascular disease (ASCVD), a risk not fully explained by traditional factors.
• Shared inflammatory pathways are central to the pathogenesis of both RA and ASCVD.
• The high cardiovascular morbidity and mortality associated with RA necessitate prioritizing therapies that address both conditions.

Purpose of the Study:

• To review therapies for RA that also offer protection against ASCVD.
• To highlight drugs that manage RA disease activity while simultaneously conferring atheroprotection.

Main Methods:

• Literature review of existing studies on RA therapies and their cardiovascular effects.
• Analysis of drug mechanisms related to inflammation, lipid metabolism, and endothelial function.

Main Results:

• Methotrexate (MTX), a common RA drug, significantly reduces cardiovascular adverse events by promoting cholesterol efflux, scavenging free radicals, and improving endothelial function.
• Sulfasalazine shows positive effects on lipid profiles, increasing HDL-C, and is linked to reduced myocardial infarction risk in RA patients.
• Biologic agents like TNF-α and IL-6 inhibitors improve endothelial function and HDL-C's anti-atherogenic properties.
• Hydroxychloroquine positively influences insulin sensitization and lipid profiles.

Conclusions:

• While no single RA therapy provides complete atheroprotection, several drugs demonstrate beneficial cardiovascular effects.
• Combination therapies for RA and ASCVD management require further investigation.