Prevention of co-morbidity
Patients with rheumatoid arthritis (RA) have approximately 50% higher mortality than the general population matched for age and gender.
Patients with RA also have an increased prevalence of co-morbidities including cardiovascular diseases, such as coronary heart disease, and respiratory diseases, such as pneumonia and lung cancer.
The accelerated atherosclerosis, a build up of fatty deposits in the arteries, in this disease is related to traditional risk factors such as smoking and hypertension, the cumulative burden of inflammation plus the complex interactions between these variables. Much of the excess risk of respiratory disease may also be related to a high prevalence of smoking amongst patients with RA.
It is unclear to what extent disease activity should be reduced, and by what means, in order to halt rapid progressions of atherosclerosis seen in RA. Many studies are cross-sectional and do not indicate the rate of change that may be observed in these parameters following introduction of new therapies.
What we aim to achieve:
We aim to develop strategies to reduce the prevalence and impact of these co-morbidities in RA.
Improved strategies to help RA patients stop smoking would benefit the health of these patients. However, while smoking is highly linked to the development of respiratory disease in RA patients, this is not the case with coronary heart disease. Here the cumulative burden of inflammation also appears to play a role and some evidence suggests that improved disease control may improve vascular function and lead to a reduced impact of coronary heart disease.
It is not currently clear whether reducing disease activity to low levels by any means (standard disease modifying therapy, biologic agents or steroid therapy) would be equally effective or if some agents are more effective than others in this respect. It is therefore important that research at NIHR Manchester Musculoskeletal BRU investigates whether the low disease activity targets sufficient to retard joint damage will be sufficient to reduce the accumulation of coronary heart disease or whether more stringent control is necessary.