Category Archives: Co-morbid conditions

Rheumatoid arthritis drugs… which ones are friendly to the heart and which ones aren’t!

Rheumatoid arthritis (RA) is a chronic, autoimmune systemic disease which affects approximately two million Americans. While the symptoms that bring the patient to the doctor are the joint swelling and pain, the area of most concern may not be the joints.  It is well established that cardiovascular risk is markedly increased in RA and in fact it is this complication that shortens lifespan by between ten to fifteen years.

A number of clinical studies have retrospectively examined the relationship between certain medications and the risk of cardiovascular events.  The report card has provided some real surprises.heart-attack_0

For example, methotrexate, the workhorse disease modifying anti-rheumatic drug (DMARD) of choice reduces cardiovascular mortality by almost 70 per cent. The mechanism is felt to be due to a reduction of atherosclerotic plaque formation as well as increased clearance of foam cells (Solomon DH, et al. Circulation 2003; 11: 1303-1307).

The other major player in the treatment of RA is the TNF inhibitor group.  These are used in more than 50 per cent of RA patients in the US. These drugs apparently reduce the risk of cardiovascular events by almost 50 per cent (Gonzalaz A, et al. Ann Rheum Dis. 2008; 67: 64-69). Why this occurs is still not clearly understood.

Steroids have been used to treat RA since the early 1950’s.  Steroids have been shown to worsen cardiovascular risk because of their effects on both blood pressure as well as blood glucose.  Steroid use in RA has been associated with increased carotid plaque formation as well as increased arterial stiffness.  So what dose is a safe dose?  The answer is still unknown.

Non-steroidal anti-inflammatory drugs (NSAIDS) raise blood pressure.  Randomized clinical trials have shown that cardiovascular risk is associated with COX-2 inhibitors but also with non-selective COX drugs also.  The upshot? All NSAIDS regardless of class, are associated with increased cardiovascular risk.

Hydroxychloroquine, a drug often used to treat mild RA, is associated with a decrease in diabetes and may also improve lipid status.  Actemra increases lipid profile but the long term effects are still unknown.  Leflunomide (Arava) increases blood pressure.  The eventual effects are still a subject of conjecture.

So what about aspirin?  This medication is used for cardiovascular prophylaxis.  In higher doses it also has anti-inflammatory effects although these are limited by the potential gastrointestinal side effects known to be caused by high dose aspirin. It is well known that other NSAIDS should not be used in patients taking aspirin for cardiovascular prophylaxis since they blunt that effect.

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Tipoffs to need for repeat joint surgery

Nancy Walsh writing in MedPage Today reported “Specific patient characteristics, such as depression and renal disease, can help predict which patients with knee or hip replacements are most likely to need repeat surgery joint-replacement-surgerywithin a year, a researcher reported” at an American Academy of Orthopaedic Surgeon meeting.

Investigators found that “in Medicare patients, one of the most significant independent risk factors for total knee arthroplasty revision within a year was chronic pulmonary disease, while depression was a main reason for revision total hip arthroplasty within 12 months.”

Several “factors influence outcomes in joint replacement surgery, including physician, health system, and device factors, but patient characteristics, particularly in older patients, have not been studied much, according to” Kevin Bozic, MD, “who presented results from two studies.”

For more information on arthritis treatments and other arthritis problems,  go to:

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Treat To Target for Rheumatoid Arthritis

Dr. Steve Paget summarized the “treat to target” approach for rheumatoid arthritis (RA) elegantly in a recent article.  He laid out ten principles that make sense.

rheumatoid-arthritisThey are:

1. The primary target for RA treatment should be clinical remission.

2. Clinical remission is defined as the absence of signs and symptoms of significant inflammation.

3. While remission is the target, low disease activity is an acceptable alternative.

4. Until the treatment target is reached, drug therapy should be adjusted every three months.

5. Measures of disease activity need to be obtained and documented every month for patients with high disease activity and every three months for patients with low disease activity.

6. Validated measures of disease activity should guide treatment decisions.

7. Structural changes and functional impairment shoulkd be considered when making clinical decisions.

8. The treatment target should be maintained indefinitely.

9. The choice of the disease measuring and the level of target should take patient factors, co-morbidities, and drug-related risk into consideration.

10. The patient needs to be informed about the treatment target and how it will be achieved.

For more information on arthritis treatments and other arthritis problems,  go to:

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Pain after knee replacement predicted by the presence of other conditions

Lynda Williams writing in Medwire reported, “Research may help physicians give patients who are undergoing total knee arthroplasty (TKA) a realistic expectation of surgery outcome based on their overall physical and mental health,” according to a study published in Rheumatology. knee-joint-replacement-surgery

Investigators found that “the likelihood of pain 2-5 years after primary or revision TKA was significantly influenced by a wide range of co-morbidities including heart disease and depression.”

it’s clear that a patient’s state of mind has a tremendous influence over the outcome of any disease or surgery.

For more information on arthritis treatments and other arthritis problems,  go to:

Arthritis Treatment

And don’t forget to sign up for  free weekly arthritis tips and a free copy of our special report “The Consumer’s Guide to Arthritis”

Just go here Contact