Journal ArticleDOI
Investigating changes in disease activity as a mediator of cardiovascular risk reduction with methotrexate use in rheumatoid arthritis
Tate M. Johnson,Harlan Sayles,Joshua F. Baker,Michael D. George,Punyasha Roul,Cheng Zheng,Brian C. Sauer,Katherine P. Liao,Daniel R. Anderson,Ted R. Mikuls,Bryant R. England +10 more
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TLDR
MTX use in RA was associated with a reduced risk of CVD events, particularly HF-related hospitalisations, suggesting alternative MTX-related mechanisms may modify CVD risk in this population.Abstract:
Objective Examine the association of methotrexate (MTX) use with cardiovascular disease (CVD) in rheumatoid arthritis (RA) using marginal structural models (MSM) and determine if CVD risk is mediated through modification of disease activity. Methods We identified incident CVD events (coronary artery disease (CAD), stroke, heart failure (HF) hospitalisation, CVD death) within a multicentre, prospective cohort of US Veterans with RA. A 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) was collected at regular visits and medication exposures were determined by linking to pharmacy dispensing data. MSMs were used to estimate the treatment effect of MTX on risk of incident CVD, accounting for time-varying confounders between receiving MTX and CVD events. A mediation analysis was performed to estimate the indirect effects of methotrexate on CVD risk through modification of RA disease activity. Results Among 2044 RA patients (90% male, mean age 63.9 years, baseline DAS28-CRP 3.6), there were 378 incident CVD events. Using MSM, MTX use was associated with a 24% reduced risk of composite CVD events (HR 0.76, 95% CI 0.58 to 0.99) including a 57% reduction in HF hospitalisations (HR 0.43, 95% CI 0.24 to 0.77). Individual associations with CAD, stroke and CVD death were not statistically significant. In mediation analyses, there was no evidence of indirect effects of MTX on CVD risk through disease activity modification (HR 1.03, 95% CI 0.80 to 1.32). Conclusions MTX use in RA was associated with a reduced risk of CVD events, particularly HF-related hospitalisations. These associations were not mediated through reductions in RA disease activity, suggesting alternative MTX-related mechanisms may modify CVD risk in this population.read more
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Treatment of early rheumatoid arthritis: Methotrexate and beyond.
TL;DR: For the last several decades, the standard of care for the initial management of rheumatoid arthritis (RA) has been methotrexate as discussed by the authors , which is effective as monotherapy and in combination with conventional, biologic, and targeted-synthetic therapies.
Journal ArticleDOI
Circulating Adipokines and Associations With Incident Cardiovascular Disease in Rheumatoid Arthritis
L. Federico,Tate M. Johnson,Bryant R. England,Katherine D Wysham,Michael D. George,Brian C. Sauer,Bartlett C. Hamilton,Carlos D. Hunter,Michael J. Duryee,Geoffrey M. Thiele,Ted R. Mikuls,Joshua F. Baker +11 more
TL;DR: It is suggested that adipokines effectively predict clinically important outcomes in RA perhaps through an association with body composition and metabolic health.
Journal ArticleDOI
Systemic complications of rheumatoid arthritis: Focus on pathogenesis and treatment
Di Wu,Yehao Luo,Tong Li,Xinyi Zhao,Ting Lv,Gang Fan,Peiqi Ou,Hongyi Li,Xiaofan Luo,An Huang,Yuzhou Pang +10 more
TL;DR: In this article , the serious complications of rheumatoid arthritis are summarized, focusing on its incidence, pathogenesis, clinical features, and treatment methods, aiming to provide a reference for clinicians to better manage the complications of RA.
Journal ArticleDOI
Methotrexate improves endothelial function in early rheumatoid arthritis patients after 3 months of treatment
Giacomo Cafaro,Eleonora Petito,Onelia Bistoni,Emanuela Falcinelli,Sabrina Cipriani,Maria Chiara Borghi,Angelo Francesco Bonifacio,Elisabetta Giglio,Alessia Alunno,Carlo Perricone,Roberto Gerli,Paolo Gresele,Elena Bartoloni +12 more
TL;DR: In this article , the effects of methotrexate (MTX) on endothelial homeostasis in early, treatment-naïve rheumatoid arthritis patients were investigated.
Journal ArticleDOI
The Association Between Rheumatoid Arthritis and Atrial Fibrillation: Epidemiology, Pathophysiology and Management
Yezhou Qian,Feige Nian +1 more
TL;DR: In this article , a review summarizes the epidemiology, pathophysiology, and management of atrial fibrillation in patients with RA, showing that RA is associated with increased incidence of cardiac arrhythmias such as AF.
References
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Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease
Paul M. Ridker,Brendan M. Everett,Tom Thuren,Jean G. MacFadyen,William Chang,Christie M. Ballantyne,Francisco H. Fonseca,Jose C. Nicolau,Wolfgang Koenig,Stefan D. Anker,John J.P. Kastelein,Jan H. Cornel,Prem Pais,Daniel Pella,Jacques Genest,Renata Cifkova,Alberto J. Lorenzatti,Tamás Forster,Zhanna Kobalava,Luminita Vida-Simiti,Marcus Flather,Hiroaki Shimokawa,Hisao Ogawa,Mikael Dellborg,Paulo Roberto Ferreira Rossi,Roland P.T. Troquay,Peter Libby,Robert J. Glynn +27 more
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Marginal Structural Models and Causal Inference in Epidemiology
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Forecasting the Impact of Heart Failure in the United States A Policy Statement From the American Heart Association
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Journal ArticleDOI
Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction
Jean-Claude Tardif,Simon Kouz,David D. Waters,Olivier F. Bertrand,Rafael Diaz,Aldo P. Maggioni,Fausto J. Pinto,Reda Ibrahim,Habib Gamra,Ghassan S. Kiwan,Colin Berry,José López-Sendón,Petr Ostadal,Wolfgang Koenig,Denis Angoulvant,Jean Grégoire,Marc-André Lavoie,Marie-Pierre Dubé,David Rhainds,Mylène Provencher,Lucie Blondeau,Andreas Orfanos,Philippe L. L’Allier,Marie-Claude Guertin,François Roubille +24 more
TL;DR: Among patients with a recent myocardial infarction, colchicine at a dose of 0.5 mg daily led to a significantly lower risk of ischemic cardiovascular events than placebo.