Lipid Profiles in Patients with Rheumatoid Arthritis: Mechanisms and the Impact of Treatment

Objective: To describe the impact of rheumatoid arthritis (RA), and its treatment, on lipoprotein levels with potential implications for atherosclerosis. Methods: A PubMed literature search was undertaken for studies published between 1990 and May 2007, using the search terms rheumatoid arthritis AND lipid OR lipoprotein, and including all relevant drug treatment terms for glucocorticoids, disease-modifying antirheumatic drugs, and biologics. Results: Patients with RA face an increased risk of developing premature cardiovascular disease and limited ability to modify risk factors, eg, through exercise. RA is associated with an abnormal lipoprotein pattern, principally low levels of high density lipoprotein (HDL) cholesterol. Most treatments for RA tend to improve the atherogenic index (total/HDL cholesterol ratio), with more evidence For biologics in this regard. The improvement in the lipoprotein profile in RA appears to be associated with suppression of inflammation. Conclusions: Lipid levels should be monitored and managed in patients with RA to minimize the long-term risk of cardiovascular disease. More research is needed to quantify the relationship between systemic inflammation and lipoprotein levels and to determine the impact of specific lipoprotein particles, eg, small dense low-density lipoprotein and subfractions of HDL on long-term risk. Control of inflammation may have an effect on modifying cardiovascular risk. (C) 2009 Elsevier Inc. All rights reserved. Semin Arthritis Rheum 38:372-381