Rheumatoid arthritis is an independent risk factor for multi-vessel coronary artery disease: a case control study.

The risk for cardiovascular (CV) disease is increased in rheumatoid arthritis (RA) but data on the burden of coronary atherosclerosis in patients with RA are lacking. We conducted a retrospective case-control study of Olmsted County (MN, USA) residents with RA and new-onset coronary artery disease (CAD) (n = 75) in comparison with age-and sex-matched controls with newly diagnosed CAD (n = 128). Angiographic scores of the first coronary angiogram and data on CV risk factors and CV events on follow-up were obtained by chart abstraction. Patients with RA were more likely to have multi-vessel coronary involvement at first coronary angiogram compared with controls (P = 0.002). Risk factors for CAD including diabetes, hypertension, hyperlipidemia, and smoking history were not significantly different in the two cohorts. RA remained a significant risk factor for multi-vessel disease after adjustment for age, sex and history of hyperlipidemia. The overall rate of CV events was similar in RA patients and controls; however, there was a trend for increased CV death in patients with RA. In a nested cohort of patients with RA and CAD (n = 27), we measured levels of pro-inflammatory CD4+CD28null T cells by flow cytometry. These T cells have been previously implicated in the pathogenesis of CAD and RA. Indeed, CD4+CD28null T cells were significantly higher in patients with CAD and co-existent RA than in controls with stable angina (P = 0.001) and reached levels found in patients with acute coronary syndromes. Patients with RA are at increased risk for multi-vessel CAD, although the risk of CV events was not increased in our study population. Expansion of CD4+CD28null T cells in these patients may contribute to the progression of atherosclerosis.

Risk factors for methotrexate-induced abnormal laboratory monitoring results in patients with rheumatoid arthritis.

OBJECTIVE: To determine risk factors for methotrexate (MTX)-induced hepatic and hematologic laboratory abnormalities in patients with rheumatoid arthritis (RA). METHODS: Measurements of aspartate aminotransferase (AST), white blood cell counts, and platelet counts were collected in a database of patients with RA receiving MTX from 1991 through 2002. Potential risk factors for toxicity were recorded on each patient. RESULTS: Four hundred and eighty-one patients were followed for 2,323 person-years of MTX exposure. MTX was discontinued permanently because of abnormal laboratory test results in 22 patients (4.6%), the majority of whom (17/22, 77%) had elevated AST values. The body mass index (BMI) was significantly higher in those patients where MTX was permanently discontinued than in those in whom it was not (p < 0.03). Independent predictors of a significantly higher percentage of abnormal AST values were lack of folate supplementation (p < 0.001) and untreated hyperlipidemia (p < 0.02). Of the 17 patients in whom MTX was discontinued permanently because of an elevated AST value, 11/17 (65%) had either lack of folate supplementation or untreated hyperlipidemia. Hypoalbuminemia correlated independently with an increased percentage of abnormal platelet counts (p < 0.03). CONCLUSION: Lack of folate supplementation, untreated hyperlipidemia, and elevated BMI identified patients receiving MTX at risk for transaminase elevation, and low serum albumin was a risk factor for thrombocytopenia. Nonalcoholic fatty liver disease could be the underlying risk factor for transaminase elevation in patients with hyperlipidemia and obesity.

Relapsing polychondritis.

SUMMARY: Relapsing polychondritis is a unique, rare autoimmune disorder in which the cartilaginous tissues are the primary targets of destruction but the immune damage can spread to involve noncartilaginous tissues like the kidney, blood vessels, and so forth. The manifestations of the disease can take many different forms and the pathogenesis is still unclear. It may occur in a primary form or it may be associated with other disease states. This article summarizes important aspects of the disease with a focus on recent information regarding clinical manifestations, disease associations, pathogenesis, and advances in therapeutics.