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

类风湿关节炎(RA)的特征在于炎症和心血管疾病(CVD)的风险增加。这项研究调查了CVD与RA中使用传统疾病缓解风湿药(DMARDs)之间的可能联系。使用病例对照设计,研究了613名RA患者(5,649患者-年),其中72例患有CVD,541例没有CVD。从RA诊断到首次心血管事件或随访期结束,评估了RA,CVD和药物治疗的数据。数据集根据DMARD使用进行了分类:柳氮磺胺吡啶(SSZ),羟氯喹(HCQ)或甲氨蝶呤(MTX)。每个DMARD组均计算出经年龄,性别,吸烟和RA持续时间校正后的CVD的赔率(OR)。从未使用过SSZ,HCQ或MTX的患者被用作参考组。 MTX治疗可显着降低CVD风险,OR为(95%CI):“仅MTX”,0.16(0.04至0.66); ``MTX和SSZ曾经'',0.20(0.08至0.51);和“ MTX,SSZ和HCQ”,0.20(0.08至0.54)。在对类风湿因子和糜烂的存在进行了进一步校正后,风险降低仍然很显着。在校正了高血压,糖尿病和高胆固醇血症后,“曾经有过MTX或SSZ”以及“曾经有过MTX,SSZ和HCQ”显示出可显着降低CVD风险。类风湿因子阳性和糜烂均增加了CVD的风险,OR分别为2.04(1.02至4.07)和2.36(0.92至6.08)。与从未使用过SSZ,HCQ或MTX的RA患者相比,MTX和较小程度的SSZ与较低的CVD风险相关。我们假设使用DMARD,尤其是使用MTX可以有效抑制炎症,从而减少动脉粥样硬化的发展,进而减少临床上明显的CVD的发生。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录