Early Cardiovascular Benefits to DMARD Treatment in Rheumatoid Arthritis Save

ARD has published a report showing that patients with early rheumatoid arthritis (ERA) have cardiovascular disease (CVD) that is modifiable with conventional and aggressive therapy and that it did not matter if first line DMARD therapy was with a tumour necrosis factor-inhibitor (TNFi) or methotrexate (MTX).

Early RA patients enrolled in the phase IV ERA trial were randomized to receive either ETN+MTX or MTX.  These patients did not have evidence of CVD but were permitted to have a maximum of one traditional risk factor.  They were assessed by cardiovascular magnetic resonance (CMR) at baseline, years 1 and 2. The primary outcome measure was aortic distensibility (AD) between matched controls and ERA. Additional outcome measures included left ventricular (LV) mass and myocardial extracellular volume (ECV).

When comparing 81 ERA patients to controls, the ERA patients:

• aortic distensibility (AD): was significantly lower (3.0×10−3 mm Hg−1 (2.7–3.3) vs 4.4×10−3 mm Hg−1 (3.7–5.2), p<0.001);
• LV mass was significantly lower (78.2 g (74.0–82.7), n=81 vs 92.9 g (84.8–101.7), n=30, p<0.01); and
• myocardial extracellular volume (ECV) was  increased (27.1% (26.4–27.9), n=78 vs 24.9% (23.8–26.1), n=30, p<0.01).
• Across all patients, AD improved significantly from baseline to year 1 (3.0×10−3 mm Hg−1 (2.7–3.4) to 3.6×10–3 mm Hg−1 (3.1–4.1), respectively, p<0.01), maintained at year 2. T
• AD improvement did not differ between the two treatment arms (MTX vs. MTX+ETN) or with disease activity state defined responders versus non-responders.

Hence, ERA  patients do have evidence of vascular and myocardial abnormalities that are significantly improved by early DMARD therapy, with no preference to MTX or biologic use.