Abstract
Objectives: Besides their proven effectivity in decreasing the risk of cardiovascular events, angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II type 1 receptor blockers (ARBs) are likely to possess anti-inflammatory properties as well. This study aims to investigate whether the use of ACEi and ARBs additionally lowers disease activity in patients with rheumatoid arthritis (RA). Methods: In this cross-sectional study, we used ARBs or ACEi to study RA patients who had at least one DAS28-CRP measurement during a one-year period. A control group of RA patients without ACEi/ARBs was randomly selected. The primary outcome was the difference between the DAS28-CRP scores of ACEi/ARBs users and controls. The secondary outcomes were the differences between administered dosages of csDMARDs and bDMARDs for users and controls, respectively; these were expressed in defined daily dose (DDD). Confounders were included in the multiple regression analyses. Results: A total of 584 ACEi/ARBs users and 552 controls were finally examined. Multiple linear regression analyses showed no association between the use of ACEi or ARBs and the DAS28-CRP scores (ACEi factor 1.00, 95% CI 0.94–1.06; ARBs 1.02, 95% CI 0.96–1.09), nor with the dosage of csDMARDs (ACEi 0.97, 95% CI 0.89–1.07; ARBs 0.99, 95% CI 0.90–1.10). Furthermore, the use of ACEi was not associated with reduced dosages of bDMARDs (OR 1.14, 95% CI 0.79–1.64), whereas ARBs users tended to use less bDMARDs (1.46, 95% CI 0.98–2.18, p = 0.06). Conclusion: In this study, the use of either ACEi or ARBs in RA patients had no impact on disease activity as measured by the DAS28-CRP. A trend towards lower bDMARD dosages was observed in ARBs users, but the significance of this finding is still unclear.
Highlights
Rheumatoid arthritis (RA) is a chronic inflammatory condition characterized by joint inflammation and several comorbidities
We further investigated whether the use of angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II type receptor blockers (ARBs) would lead to a reduction of Disease Modifying Anti-Rheumatic Drugs (DMARDs) dosage, which is common practice when RA patients enter longer periods of remission or low disease activity (LDA)
We found no significant association between the use of either ACEi or ARBs and lower dosages of conventional synthetic DMARD (csDMARD) or biological DMARD (bDMARD) in these patients
Summary
Rheumatoid arthritis (RA) is a chronic inflammatory condition characterized by joint inflammation and several comorbidities. RA is associated with an increased risk of cardiovascular (CV) morbidity and mortality [1]. This increased CV risk is mainly attributed to accelerated atherosclerosis, which can rely on traditional risk factors (including smoking, obesity, hypertension, and dyslipidaemia), as well as non-traditional/RA-related factors [2]. From among the latter, systemic inflammation seems to be pivotal [3], but other factors, including a certain genetic background and impaired physical activity, might add to the increased CV risk in these patients [4]. It is worth mentioning that all these factors are interacting with each other in a complex network, in which bidirectional and synergistic effects can occur, including inflammation [6]
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