Researchers at the University of Nebraska Medical Center have published a clinical review that finds a consistent increase of cardiovascular disease in patients with rheumatoid arthritis.
The review appears April 23 on the front page of the British Medical Journal, a leading science journal. Journal articles serve to alert health providers to new medical information providers may use to help determine treatment for their patients.
The findings come from researchers summarizing the overall body of evidence accumulated over the last decade of cardiovascular disease in rheumatoid arthritis from a large number of independent studies. The studies range from in vitro and animal model studies to meta-analyses of large clinical trials and observational studies.
"The ‘take home message’ is that rheumatoid arthritis does not solely target the joints," said Bryant England, M.D., assistant professor, UNMC Division of Rheumatology & Immunology. "Rheumatoid arthritis is a systemic disease with several mechanisms by which it increases the risk of cardiovascular disease.
He said because cardiovascular risk encompasses multiple mechanisms, health care providers need to implement a multi-faceted approach to prevent cardiovascular events in rheumatoid arthritis patients.
"This includes treating the rheumatoid arthritis aggressively, using medications that change the disease course of rheumatoid arthritis, smoking cessation efforts, managing traditional cardiovascular risk factors (diabetes, high blood pressure, cholesterol), limiting the use of medications linked to cardiovascular disease, and encouraging a healthy lifestyle (e.g. diet and exercise)," Dr. England said.
He and his colleagues hope to disseminate the findings to the medical community.
Through the review, Dr. England said the team learned that the amount of cholesterol and how well the cholesterol functions is altered by rheumatoid arthritis and the medications used to treat rheumatoid arthritis. Understanding the mechanisms, implications, and management of the cholesterol changes is an area of active investigation by several groups.
"Several mechanisms beyond traditional cardiovascular risk factors confer this risk. Treating rheumatoid arthritis aggressively with disease-modifying anti-rheumatic drugs, limiting use of corticosteroids and non-steroidal anti-inflammatory drugs, and aggressively managing traditional cardiovascular risk factors are essential to reduce the substantial burden posed by this common presence of these two chronic diseases," Dr. England said.
In addition to Dr. England, other UNMC faculty involved in the study were Geoffrey Thiele, Ph.D., Ted Mikuls, M.D., all who have appointments at the Veterans Affairs (VA) Nebraska-Western Iowa Health Care System and Daniel Anderson, M.D., Ph.D.
The paper can be found at https://www.bmj.com/content/361/bmj.k1036.
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