Abstract
Rheumatoid arthritis (RA) carries significant risk for atherosclerotic cardiovascular disease (ASCVD). Traditional ASCVD risk factors fail to account for this accelerated atherosclerosis. Shared inflammatory pathways are fundamental in the pathogenesis of both diseases. Considering the impact of RA in increasing cardiovascular morbidity and mortality, the characterization of therapies encompassing both RA and ASCVD management merit high priority. Despite little progress, several drugs discussed here promote remission and or lower rheumatoid disease activity while simultaneously conferring some level of atheroprotection. Methotrexate, a widely used disease-modifying drug used in RA, is associated with significant reduction in cardiovascular adverse events. MTX promotes cholesterol efflux from macrophages, upregulates free radical scavenging and improves endothelial function. Likewise, the sulfonamide drug sulfasalazine positively impacts the lipid profile by increasing HDL-C, and its use in RA has been correlated with reduced risk of myocardial infraction. In the biologic class, inhibitors of TNF-α and IL-6 contribute to improvements in endothelial function and promote anti-atherogenic properties of HDL-C, respectively. The immunosuppressant hydroxychloroquine positively affects insulin sensitization and the lipid profile. While no individual therapy has elicited optimal atheroprotection, further investigation of combination therapies are ongoing.
Highlights
Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disorder that leads to the breakdown of immune tolerance [1]
RA plasma can foster a combination of attenuated cholesterol outflow and increased scavenger receptor-mediated oxidized low density lipoprotein (LDL) uptake by monocytes and macrophages via the downregulation of a set of cholesterol efflux proteins (ABCA1, ABCG1, 27-hydroxylase) coupled with the upregulation of scavenger receptors (CD36, LOX1 and CXCL16)
This paper explores the effects of cholesterol-lowering therapy and of the individual drugs used in TARGET
Summary
Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disorder that leads to the breakdown of immune tolerance [1]. It affects women disproportionately and usually presents between the ages of 40–60 [2,3]. Worldwide prevalence of RA is approximately 0.5–1% [4] This disorder primarily manifests as joint pain, swelling and stiffness. It is well established that RA confers increased risk for atherosclerotic cardiovascular disease (ASCVD), a chronic inflammatory and lipid-depository disease [10,11]. In comparison to the general population, RA patients have a CVD risk approximately 50% higher and a 1.6 times higher rate of acute myocardial infarction and ischemic stroke [15,16].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
