Lower Lipids in Inflammatory Arthritis May Lower CV Risk

Patients with inflammatory arthritis, including rheumatoid arthritis (RA) and psoriatic arthritis (PsA), are at greater risk for cardiovascular (CV) problems. Intensive treatment with statins may help prevent such problems by reducing carotid artery plaques, according to a small study from Norway.

The study of 86 patients with asymptomatic carotid plaques shows that intensive treatment with rosuvastatin (Crestor) to lower to lower “bad” low-density lipoprotein (LDL) cholesterol to 70 mg/dL or below significantly trims the size of carotid plaques seen on ultrasound.

The presence of carotid plaques seen on ultrasound in inflammatory arthritis patients (specifically in RA) is regarded as a predictor of future acute coronary syndromes. But this is the first time lipid-lowering treatment has been tested in patients who have not had a CV event, the researchers note.

The ROsuvastatin in Rheumatoid Arthritis, Ankylosing Spondylitis and other inflammatory joint diseases (RORA-AS) study followed patients with inflammatory arthritis – 55 with RA, 10 with PsA, and 21 with ankylosing spondyloarthritis (AS) -- for 18 months . There was a reduction in plaque thickness along with a drop in LDL.

More than half of the patients, 60% of whom were women (mean age 61), who’d had their disease for an average of 17 years, had multiple carotid plaques. In most of those patients, thickness was reduced in over half of the plaques after 18 months.

The thickest plaques showed the biggest reduction in size, especially among the youngest patients.

Almost 62% of the study group reached the LDL cholesterol-lowering goal of 70 mg/dL or below. Interestingly, achieving that goal did not seem to influence the degree of reduction in the height of the plaques, the researchers report.

Disease activity scores in 28 joints (DAS28) were lower among those with the greatest plaque size reduction. Statins have been shown to reduce inflammation as measured by C-reactive protein (CRP), the study authors note.

The study was limited by the lack of placebo and fact that patients received DMARDs, such as TNF blockers -- which some studies suggest may help reduce heart risk – which could have skewed the results.

References:

Rollefstad S, Ikdahl E, Hisdal J, et al., Rosuvastatin-induced carotid plaque regression in patients with inflammatory joint diseases: the Rosuvastatin in Rheumatoid Arthritis, Ankylosing Spondylitis and Other Inflammatory Joint Diseases Study. Arthritis & Rheumatology. 2015;67(7):1718–1728, July 2015. Article first published online: 26 JUN 2015. DOI: 10.1002/art.39114.