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Posted by on Feb 26, 2019 in Rheumatoid Arthritis | 0 comments

In a nutshell

This study investigated if a treat-to-target (TTT) approach reduces cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA). They found that TTT reduced CVD risk in patients with RA over 5 years. 

Some background

Rheumatoid arthritis (RA) is a chronic condition caused by inflammation. Patients with RA have a 50% risk of developing cardiovascular disease (CVD). CVD includes conditions such as atherosclerosis (ASC). ASC is caused by the build-up of cholesterol inside the artery. These are called plaques. One factor that contributes to ASC is inflammation. 

In addition to treating RA, it is important to manage other risks. Patients with RA that have CVD symptoms are treated according to standard CVD guidelines. Some studies suggest that early intervention is important to manage CVD risk in RA. A target-to-treat (TTT) approach is used to do this. TTT involves treating CVD symptoms with specific guidelines. It is unclear if TTT is more beneficial than standard care in reducing CVD risk in RA.

Methods & findings

This study included 219 patients with RA. Patients were assigned to one of two groups. 103 patients received standard care for CVD by their doctor if required. 116 patients  were treated using the TTT protocol. The TTT protocol uses medication to manage CVD symptoms such as high blood pressure. All patients were treated as normal for their RA symptoms. The thickness of the inner layer of the carotid artery called cIMT was measured using ultrasound. This assesses plaque build-up in the artery. The study lasted 5 years. 

Average blood pressure readings were similar in both groups of patients (72.4% vs. 75.9%, standard vs. TTT). Low-density lipoprotein C (LDL-C; bad cholesterol) levels were lower in TTT patients after 1 year. RA was well controlled in both groups. cIMT was significantly improved in TTT patients compared to standard care. CV events occurred in 1.3% of the TTT group and 4.7% in standard care patients. Patients with CVD risk greater than 10% had significantly improved blood pressure and LDL-C levels. 

The bottom line

The authors concluded that TTT reduced CVD risk in patients with RA over 5 years.

The fine print

This study was relatively small. Larger studies are needed to confirm these observations. 

What’s next?

If you have any concerns regarding RA management, please discuss this with your doctor. 

Published By :

Annals of the rheumatic diseases

Date :

Jan 04, 2019

Original Title :

Effect of a treat-to-target intervention of cardiovascular risk factors on subclinical and clinical atherosclerosis in rheumatoid arthritis: a randomised clinical trial.

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