Using tumor necrosis factor inhibitors decreases risk of heart attacks in rheumatoid arthritis patients

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

Patients with RA also have an increased risk of heart attacks, possibly due to the inflammation associated with the disease. Researchers recently investigated whether or not anti-TNFs, which help to control RA inflammation, would lower the risk and severity of heart attacks in these patients compared to traditional, non-biologic disease-modifying antirheumatic drugs, or DMARDs.

"The British Society for Rheumatology Biologics Register was established in 2001 to monitor the long-term safety of biologic therapies in patients with rheumatoid arthritis. Information has been collected on over 20,000 UK patients, including data on all hospital admissions and deaths. Whilst established to examine possible safety issues with biologic therapies, it provides the opportunity to look at additional benefits beyond the direct effect on disease severity," explains William Dixon, MD, MRC clinician scientist/ senior clinical lecturer and honorary consultant rheumatologist; Arthritis Research UK Epidemiology Unit, The University of Manchester; and an investigator in the study. "Linkage to a national audit of myocardial infarctions [heart attacks] allowed us to examine not only the rate of heart attacks, but uniquely whether the severity of heart attacks was different following biologic treatment. Better control of inflammation with biologic therapy might reduce not only the rate of heart attacks, but potentially also affect the size of myocardial infarctions."

The researchers analyzed data regarding the rate of heart attacks in a total of 14,258 RA patients from 2001 to 2008. The researchers used linked data from two existing UK studies on the safety of biologic agent use in treating RA and a national database of heart attack-related hospitalizations in England and Wales. Using data from the biologic agent study, they identified 252 verifiable first heart attack among these patients, including 58 in 3,058 patients using traditional DMARDs and 194 in 11,200 patients using biologic agents. When the additional data from the hospitalization study was taken into account, they identified 143 heart attacks, including 35 in the DMARD group and 108 in the biologic group. The rate of heart attacks was lower in the biologic group, generating an adjusted hazard ratio of heart attacks of 0.61 in the tumor necrosis factor group compared to the DMARD group.

The researchers concluded that the RA patients using biologic agents to manage their inflammation had a lower risk of heart attacks than those who used traditional DMARDs. However, the severity of the heart attacks between the two groups was statistically similar.

"Rheumatologists can be reassured that treatment of active rheumatoid arthritis with anti-TNF therapy may lead not just to an improvement in joint symptoms, but also a reduction in the rate of myocardial infarctions in the medium term," says Dr. Dixon

Patients should talk to their rheumatologists to determine their best course of treatment.