April 26, 2002

Patients with rheumatoid arthritis who take the common drug methotrexate may have a reduced risk of dying, particularly from cardiovascular disease, according to a study in the April 6 issue of The Lancet. Hyon Choi, MD, MPH, of the MGH Rheumatology Unit, is first author of the report that analyzed data from more than 1,200 patients with rheumatoid arthritis. Almost 600 of these patients were treated with methotrexate, which reduces the inflammation that characterizes the illness. Although those placed on methotrexate therapy had more severe arthritis, patients taking the medication had a 60 percent reduction in their risk of dying during the average six-year follow-up period.

Rheumatoid arthritis is an autoinflammatory disease in which the body’s immune system mistakenly attacks joint tissues. In addition to experiencing joint pain and swelling, patients with rheumatoid arthritis have a reduced life expectancy, with increased deaths from cardiovascular disease, infection and malignancy. This was the first prospective study to examine whether methotrexate, which improves quality of life in rheumatoid arthritis patients, also could have an effect on mortality.

The research team, which includes scientists from Harvard School of Public Health and the University of Kansas, notes that the drop in cardiovascular deaths could relate to reduced overall inflammation — which also has a role in heart disease — and to improved mobility and exercise among patients. They note that further studies may clarify the mechanisms involved and point to improvements in therapy.

"The increased risk of cardiovascular disease in patients with rheumatoid arthritis and the growing consensus that chronic inflammation plays a major role in cardiovascular disease suggest that these results may have several important applications," says Choi.