Early treatment reduces the cardiovascular risk factors in newly diagnosed rheumatoid arthritis patients.
OBJECTIVE
To investigate subclinical atherosclerosis and the effect of treatment in patients with early rheumatoid arthritis (RA).


METHODS
Forty patients with early RA who met the revised American College of Rheumatology (ACR) criteria and disease duration of <1 year were included in the study. Smokers and patients with classical risk factors for atherosclerosis were excluded. The serum levels of total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol were determined in all patients before and after 1 year of therapy. Carotid artery intima-media thickness (IMT) and carotid plaque were measured before and after treatment. RA disease activity was measured using the 28 joint indices score (DAS-28) and clinical improvement was determined by the ACR response criteria. Forty-five age- and sex-matched nonsmoking volunteers were used as controls. All patients were treated with methotrexate and prednisone.


RESULTS
RA patients had a baseline mild dyslipidemia characterized by a decrease in serum HDL-C levels and a high TC/HDL-C atherogenic ratio compared with controls. Both lipid parameters were significantly improved after treatment (P<0.01). Common carotid artery IMTs at baseline were higher in RA patients compared with controls (P<0.05). After 1 year of therapy there was a significant decrease in the IMTs (P<0.001). Thirty-five patients (88%) achieved the ACR 20%, while 30 (75%) reached the ACR 50% response criteria. A significant decrease of DAS-28 was observed after treatment (P<0.03).


CONCLUSIONS
The atherogenic lipid profile and subclinical atherosclerosis are features of early RA, which improved after therapy. Early intervention and control of the disease activity may reduce the risk of atherosclerosis and cardiovascular events in patients with RA.
Georgiadis
Athanasios N
AN
Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
Voulgari
Paraskevi V
PV
Argyropoulou
Maria I
MI
Alamanos
Yannis
Y
Elisaf
Moses
M
Tselepis
Alexandros D
AD
Drosos
Alexandros A
AA
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D002318:Cardiovascular Diseases / Q000150:complications*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D012307:Risk Factors
D007166:Immunosuppressive Agents; D011241:Prednisone; D008727:Methotrexate