Clinical Edge

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DMARDs decreased vascular stiffness in early rheumatoid arthritis

Key clinical point: Adult treatment-naïve patients with early RA showed improvement in vascular stiffness after first-line treatment with either etanercept plus methotrexate or a methotrexate treat-to-target strategy with or without escalation to etanercept plus methotrexate.

Major finding: Measures of aortic distensibility at baseline were significantly lower in patients compared with controls, and significantly improved from baseline to 1 year, from 3.0×10−3 mm Hg−1 to 3.6×10–3 mm Hg−1 (P < 0.01) across both treatment groups.

Study details: The data come from a phase 4, randomized, controlled trial of 81 adult patients with early RA and no known history of cardiovascular disease and 30 matched controls; the primary outcome was aortic distensibility based on cardiovascular MRI at baseline and at 1 year.

Disclosures: The study was supported by the National Institute for Health Research, and the National Institute for Health Research Leeds Biomedical Research Centre. The parent study was supported by Pfizer. Several coauthors disclosed relationships with companies including Pfizer; lead author Dr. Plein had no financial conflicts to disclose.


The cardiovascular risk associated with established rheumatoid arthritis (RA), thought to be multi-factorial, as well as its improvement with control of disease activity are well-recognized. This study of patients with treatment-naïve early RA reveals interesting preliminary findings of cardiovascular changes with early disease. Patients with early RA and no history of cardiovascular disease from an earlier inception cohort study were found to have abnormal vascular stiffness, a predictor of cardiovascular events, at the time of diagnosis compared to healthy volunteers. Treatment with etanercept + methotrexate or methotrexate alone improved vascular stiffness at 2 year follow-up; however, vascular stiffness did not change with disease activity or response to therapy. This study suggests a potential early cardiovascular dysfunction associated with RA that may respond to treatment, and merits further investigation as to the benefits of early aggressive RA treatment.”

Arundathi Jayatilleke, MD

Lewis Katz School of Medicine, Temple University


Plein S et al. Ann Rheum Dis. 2020 Aug 28. doi:10.1136/ annrheumdis-2020-217653.