Methotrexate, Blood Pressure and Arterial Wave Reflection in Rheumatoid Arthritis

Leena R Baghdadi^1,2,3, Richard J Woodman², E Michael Shanahan⁴ and Arduino A Mangoni³, ¹Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia, ²Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, Australia, ³Department of Clinical Pharmacology, Flinders University, Adelaide, Australia, ⁴Department of Rheumatology, Flinders University, Adelaide, Australia

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Atherosclerosis, Cardiovascular disease, methotrexate (MTX) and rheumatoid arthritis (RA)

Session Information

Date: Sunday, November 8, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Methotrexate (MTX) use has been associated with reduced cardiovascular morbidity and mortality in patients with rheumatoid arthritis (RA). Although MTX has anti-inflammatory effects, there is little evidence to support additional salutary effects on markers of cardiovascular risk such as blood pressure (BP) and arterial wave reflection (augmentation index, AIx), an indirect marker of arterial stiffness. Observational studies have suggested a lower systolic BP (SBP) in MTX users, approximately 3 mmHg, but it is unknown whether this is independent of anti-inflammatory effects. Thus, the purpose is to investigate associations between MTX, SBP and AIx in RA patients.

Methods: Using a cross-sectional study design, a total of 86 patients with RA (diagnosed using the 2010 American College of Rheumatology criteria) were recruited from rheumatology outpatient clinics at Flinders Medical Centre and Repatriation General Hospital, Adelaide, Australia. Participants were classified according to MTX exposure: MTX and non-MTX (defined as off MTX for >1 year or MTX naïve).

Results: There were 56 MTX (70% female; mean age 61 years) and 30 non-MTX patients (76% female; mean age 63 years). After adjusting for age, mean ±SD clinical SBP was significantly lower in MTX patients (124±1.9 mmHg, p<0.001) compared to non-MTX patients (131±2.9 mmHg, p<0.001). There were similar differences for central SBP 115 ±1.9 vs. 122 ±3 mmHg, p<0.001). MTX use was also associated with lower AIx (28%, 95% CI= 25.7, 29.9 vs. 31%, 95% CI= 27.5, 34.5, p< 0.001). Changes in the global inflammatory marker (ESR) and disease activity score (DAS28) and anti-CCP were not significantly associated with clinical SBP (p=0.80, 0.79 and 0.65) or AIx (p=0.86, 0.76 and 0.051), respectively. Changes in the short-term inflammatory marker CRP were associated with SBP (β=0.42±0.17, p=0.02), but not AIx (β=0.86±0.1, p=0.37).

Conclusion: Our findings show that the use of MTX is associated with lower systolic blood pressure, which is associated with reduced inflammation. The lower arterial wave reflection in MTX patients was independent of changes in inflammation.

Disclosure: L. R. Baghdadi, None; R. J. Woodman, None; E. M. Shanahan, None; A. A. Mangoni, None.

To cite this abstract in AMA style:

Baghdadi LR, Woodman RJ, Shanahan EM, Mangoni AA. Methotrexate, Blood Pressure and Arterial Wave Reflection in Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/methotrexate-blood-pressure-and-arterial-wave-reflection-in-rheumatoid-arthritis/. Accessed .

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