Exercise and anti-TNF medication – can this combination improve cardiovascular health in patients with rheumatoid arthritis?

This study investigated if exercise and anti-TNF medication can improve cardiovascular health (CVH) in patients with rheumatoid arthritis (RA).

They found that combining exercise and anti-TNF medication improved CVH in these patients.

Rheumatoid arthritis (RA) is a long-term condition caused by inflammation in the joints. Inflammation leads to painful swelling which can cause disability and reduced quality of life. Patients with RA also have a higher risk of cardiovascular disease (CVD). CVD affects the heart and circulatory system (arteries and veins). In patients with RA, CVD may be caused by a number of factors such as inflammation or high blood pressure (BP).  

Doctors recommend using medication and lifestyle changes to manage CVD risk. Anti-tumor necrosis factor (anti-TNF) drugs are used to reduce inflammation in RA. Regular exercise can reduce CVD risk in the general population. Recent studies suggest exercise may also reduce CVD risk in patients with RA. It is unclear if anti-TNFs and exercise can improve CVH in RA patients. 

This study analyzed two separate reports. In one report, 20 patients with RA were included in a 3-month exercise trial. The exercise program was developed for each individual. In the second report, 23 patients with RA were included. Patients were prescribed anti-TNF drugs. These included adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade). In both, studies patients were evaluated after 3 months of treatment. RA disease activity and CVD risk factors were assessed.

Anti-TNF treatment reduced markers of inflammation after 3 months. Exercise improved functional ability and fatigue at 3 months. Anti-TNF treatment reduced diastolic BP and increased cholesterol. Exercise improved vascular function. It also reduced the Framingham Risk Score (measures 10-year CVD risk).

The authors concluded that combining exercise and anti-TNF medication can improve CVH in patients with RA.

Patients in the anti-TNF study had higher disease activity at baseline. The number of patients was small and larger studies are needed for more conclusive results.