Rheumatoid arthritis (RA) is characterized by inflammation and an increased risk for cardiovascular disease (CVD). This study investigates possible associations between CVD and the use of conventional disease-modifying antirheumatic drugs (DMARDs) in RA. Using a case control design, 613 RA patients (5,649 patient-years) were studied, 72 with CVD and 541 without CVD. Data on RA, CVD and drug treatment were evaluated from time of RA diagnosis up to the first cardiovascular event or the end of the follow-up period. The dataset was categorized according to DMARD use: sulfasalazine (SSZ), hydroxychloroquine (HCQ) or methotrexate (MTX). Odds ratios (ORs) for CVD, corrected for age, gender, smoking and RA duration, were calculated per DMARD group. Patients who never used SSZ, HCQ or MTX were used as a reference group. MTX treatment was associated with a significant CVD risk reduction, with ORs (95% CI): 'MTX only', 0.16 (0.04 to 0.66); 'MTX and SSZ ever', 0.20 (0.08 to 0.51); and 'MTX, SSZ and HCQ ever', 0.20 (0.08 to 0.54). The risk reductions remained significant after additional correction for the presence of rheumatoid factor and erosions. After correction for hypertension, diabetes and hypercholesterolemia, 'MTX or SSZ ever' and 'MTX, SSZ and HCQ ever' showed significant CVD risk reduction. Rheumatoid factor positivity and erosions both increased CVD risk, with ORs of 2.04 (1.02 to 4.07) and 2.36 (0.92 to 6.08), respectively. MTX and, to a lesser extent, SSZ were associated with significantly lower CVD risk compared to RA patients who never used SSZ, HCQ or MTX. We hypothesize that DMARD use, in particular MTX use, results in powerful suppression of inflammation, thereby reducing the development of atherosclerosis and subsequently clinically overt CVD.

译文

类风湿性关节炎 (RA) 的特征是炎症和心血管疾病 (CVD) 的风险增加。这项研究调查了CVD与RA中常规缓解疾病的抗风湿药 (DMARDs) 的使用之间的可能关联。使用病例对照设计,研究了613例RA患者 (5,649患者年),72例CVD患者和541例无CVD患者。从RA诊断到第一次心血管事件或随访期结束,评估RA,CVD和药物治疗的数据。根据DMARD用途对数据集进行分类: 柳氮磺吡啶 (SSZ),羟基氯喹 (HCQ) 或甲氨蝶呤 (MTX)。每个DMARD组计算CVD的比值比 (ORs),校正年龄,性别,吸烟和RA持续时间。从未使用SSZ,HCQ或MTX的患者被用作参考组。MTX治疗与显著降低CVD风险相关,ORs (95% CI): “仅MTX”,0.16 (0.04至0.66); “MTX和SSZ”,0.20 (0.08至0.51); 和 “MTX,SSZ和HCQ”,0.20 (0.08至0.54)。在对类风湿因子和侵蚀的存在进行进一步校正后,风险降低仍然显着。校正高血压,糖尿病和高胆固醇血症后,'MTX或SSZ ever' 和 'MTX,SSZ和HCQ ever' 显示出明显的CVD风险降低。类风湿因子阳性和糜烂均增加了CVD风险,or分别为2.04 (1.02至4.07) 和2.36 (0.92至6.08)。与从未使用SSZ,HCQ或MTX的RA患者相比,MTX和SSZ在较小程度上与CVD风险显着降低相关。我们假设使用DMARD,特别是使用MTX,可以有效抑制炎症,从而减少动脉粥样硬化的发展,并随后在临床上明显减少CVD。

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