Methotrexate & rheumatoid arthritis associated atherosclerosis: A narrative review of multidisciplinary approach for risk modification by the international board of experts

Ashot Avagimyan; Federica Fogacci; Nana Pogosova; Lev Kakturskiy; Zinaida Jndoyan; Andrea Faggiano; Tamara Bairamyan; Luciano Agati; Yasar Sattar; Lusine Mkrchyan; Gayane Avetisyan; Knarik Ginosyan; Anahit Aznauryan; Karmen Sahakyan; Artem Trofimenko; Olga Urazova; Liudmila Mikhaleva; Rositsa Vandysheva; Eugenia Kogan; Tatiana Demura; Manish Kc; Davood Shafie; Stefania Nicola; Luisa Brussino; Arrigo Cicero; Giuseppe Biondi-Zoccai; Nizal Sarrafzadegan

doi:10.1016/j.cpcardiol.2023.102230

Methotrexate & rheumatoid arthritis associated atherosclerosis: A narrative review of multidisciplinary approach for risk modification by the international board of experts

Curr Probl Cardiol. 2024 Feb;49(2):102230. doi: 10.1016/j.cpcardiol.2023.102230. Epub 2023 Nov 29.

Authors

Ashot Avagimyan¹, Federica Fogacci², Nana Pogosova³, Lev Kakturskiy⁴, Zinaida Jndoyan⁵, Andrea Faggiano⁶, Tamara Bairamyan⁷, Luciano Agati⁸, Yasar Sattar⁹, Lusine Mkrchyan¹⁰, Gayane Avetisyan¹¹, Knarik Ginosyan¹², Anahit Aznauryan¹³, Karmen Sahakyan¹⁴, Artem Trofimenko¹⁵, Olga Urazova¹⁶, Liudmila Mikhaleva¹⁷, Rositsa Vandysheva¹⁸, Eugenia Kogan¹⁹, Tatiana Demura²⁰, Manish Kc²¹, Davood Shafie²², Stefania Nicola²³, Luisa Brussino²⁴, Arrigo Cicero²⁵, Giuseppe Biondi-Zoccai²⁶, Nizal Sarrafzadegan²⁷

Affiliations

¹ MD, PhD, Assistant Professor, Department of Anatomical Pathology and Clinical Morphology, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia. Electronic address: dr.ashotavagimyan@gmail.com.
² MD, Research Fellow, Atherosclerosis and Metabolic Disorders Research Unit, University of Bologna, Bologna, Italy.
³ MD, PhD, Professor, Head of Laboratory of Preventive Cardiology, Deputy Director for Science and Preventive Cardiology, National Medical Research Center of Cardiology named after academician E. Chazov, Moscow, Russia.
⁴ MD, Ph.D, Scientific Director, A. P. Avtsyn Research Institute of Human Morphology of Petrovskiy NRCS, Moscow, Russia.
⁵ MD, PhD, Head of Internal Diseases Propaedeutic Department, Head of Internal Medicine Unit of University Clinical Hospital, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.
⁶ MD, PhD, Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; Department of Clinical Sciences and Community Health, University of Milano, Italy.
⁷ MD, PhD, Associate Professor, Department of Rheumatology, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.
⁸ MD, PhD, Head of Cardiology Unit Aziendo Umberto II, Department of Cardiology, La Sapienza University of Rome, Rome, Italy.
⁹ MD, Department of Cardiology, West Virginia University, Morgantown, WV, USA.
¹⁰ MD, PhD, Associate Professor, Department of Cardiology, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.
¹¹ MD, PhD, Associate Professor, Department of Topographical Anatomy and Operative Surgery, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.
¹² MD, PhD, Head of Rheumatology Department, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.
¹³ PhD, Associate Professor, Histology Department, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.
¹⁴ PhD, Professor, Head of Histology Department, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.
¹⁵ MD, PhD, Associate Professor, Department of Pathophysiology, Kuban State Medical University, Krasnodar, Russia.
¹⁶ MD, PhD, Professor, Head of Pathophysiology Department, Siberian State Medical University, Tomsk, Russia.
¹⁷ MD, PhD, Director, A. P. Avtsyn Research Institute of Human Morphology of Petrovskiy NRCS, Moscow, Russia.
¹⁸ MD, PhD, A. P. Avtsyn Research Institute of Human Morphology of Petrovskiy NRCS, Moscow, Russia.
¹⁹ MD, PhD, Professor, Head of Anatomical Pathology Department, I. M. Sechenov First Moscow State Medical University, Moscow, Russia.
²⁰ MD, PhD, Professor, Director of Institute of Clinical Morphology and Digital Pathology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia.
²¹ MD, North Alabama Medical Centre, Florence, Alabama, USA.
²² MD, PhD, Director of Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
²³ MD, PhD, Immunology and Allergy Unit, AO Ordine Mauriziano di Torino and Department of Medical Sciences, University of Turin, Italy.
²⁴ MD, PhD, Director of the Allergy and Immunology unit AO Ordine Mauriziano di Torino - Department of Medical Sciences, University of Turin, Italy.
²⁵ MD, PhD, Professor, Atherosclerosis and Metabolic Disorders Research Unit, University of Bologna, Bologna, Italy.
²⁶ MD, PhD, Professor, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy.
²⁷ MD, Professor, Director of Isfahan Cardiovascular Research Center (WHO Collaboration Center), Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.

PMID: 38040221
DOI: 10.1016/j.cpcardiol.2023.102230

Abstract

Rheumatoid arthritis (RA) is an idiopathic, autoimmune connective tissue disorder that primarily affects the synovial joints, causing symmetric, erosive-deforming polyarthritis. It is also associated with extra-articular manifestations, particularly cardiovascular (CV) diseases (CVD). CV risk modification in RA remains unsolved despite recent advances in the management of RA. RA is an independent risk factor for atherosclerosis. RA and atherosclerosis share similar pathophysiological features (such as the pro-inflammatory cascade activation including interleukin-6) and risk factors (such as microflora dysbacteriosis and smoking). Patients with RA experience an exacerbation of atherogenesis, with atheromas destabilization, endothelial dysfunction, vasculitis, and hypercytokinemia. Consequently, the inflammatory response associated with RA is the basis for CVD development. The treat-to-target strategy not only improved RA control but also had a favorable effect on the morpho-functional state of the CV system in patients living with RA. Thus, disease-modifying antirheumatic drugs (DMARDs) - in particular methotrexate - may have a beneficial effect on the prevention of CV events in RA. It must be mentioned that RA is a serious multi-system disease, not only because of a window period during which the course of RA can be reversed, but also due to early damage to the heart and blood vessels. For this reason, a thorough cardiological assessment must be performed for all patients with RA, regardless of sex, age, disease stage, and disease activity score.

Publication types

Review

MeSH terms

Antirheumatic Agents* / adverse effects
Arthritis, Rheumatoid* / complications
Arthritis, Rheumatoid* / drug therapy
Atherosclerosis* / etiology
Atherosclerosis* / prevention & control
Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / etiology
Cardiovascular Diseases* / prevention & control
Humans
Methotrexate / adverse effects
Risk Factors

Substances

Methotrexate
Antirheumatic Agents