Different anti rheumatic medications have varied Heart Failure risk in Rheumatoid Arthritis is the finding of a new study.
Anti-rheumatic medications are variably associated with heart failure(HF) risk, with lower risk observed among patients taking non-biologic or other biologic/small molecule DMARDs or systemic corticosteroids, according to the research presented at the 2018 ACR/ARHP Annual Meeting, held in Chicago.
Rheumatoid arthritis (RA) is associated with increased risk of coronary artery disease (CAD), but the association with heart failure (HF) is unclear. Michael Ahlers and associates conducted a study to identify factors associated with HF risk among patients with rheumatoid arthritis.
The investigators retrospectively identified 9,492 adult RA patients (median age 56 years, 76% female) without prevalent HF at RA diagnosis. RA diagnosis was defined as ≥2 RA specific ICD-9 codes that were ≥ 14 days apart and an anti-rheumatic medication prescription.
Medication categories were: non-biologic disease modifying anti-rheumatic drug (DMARD) [azathioprine, cyclophosphamide, leflunomide, methotrexate, sulfasalazine]; anti-tumor necrosis factor (TNF) [adalimumab, certolizumab, etanercept, golimumab, infliximab]; antimalarial [chloroquine, hydroxychloroquine, quinacrine]; other biologic/small molecule DMARD [abatacept, anakinra, rituximab, tocilizumab, tofacitinib]; and systemic corticosteroid.
Incident HF was defined as ≥1 ICD-9 code with diuretic use within 90 days. The associations between demographic, clinical factors and medications with the risk of incident HF were quantified with multivariable-adjusted logistic regression. The median follow-up time period was 5.0 years.
The key study findings included are:
- A total of 522 RA patients (5.5%) developed incident HF.
- Increasing age, CAD, atrial fibrillation, as well as higher body mass index, heart rate, pulse pressure, and creatinine at baseline (first RA ICD-9 code) were each associated with greater HF risk.
- The risk of HF varied by use of anti-rheumatic medication class before HF.
- Non-biologic DMARDs, other biologic/small molecule DMARDs, and systemic corticosteroids were associated with lower HF risk for all.
- Anti-TNF agents and antimalarials were not associated with the risk of HF.
Rheumatoid arthritis is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body.