RA patients who use methotrexate have been shown to have lower cardiovascular mortality compared to non-users; however, the mechanism underlying this protection is unclear. Here, Reiss et al (Arthritis Rheum 2008; 58(12): 3675) explore the atheroprotective effects of methotrexate in an experimental model of atherogenesis. Methods THP-1 monocytes/macrophages and human donor peripheral blood mononuclear cells [...]
The potential for hepatotoxicity is a well-recognized feature of therapy with a number of DMARDs in rheumatoid arthritis (RA), with methotrexate (MTX) being the most common utilized. Concomitant use of other hepatotoxic agents has the potential to compound the risk of significant liver damage. Among these, isoniazid (INH) is increasingly used in RA patients receiving MTX with evidence of latent tuberculosis infection (LTBI) or prior active tuberculosis for whom TNF inhibitor therapy is planned.
Patients with early inflammatory arthritis not meeting classification criteria for rheumatoid arthritis (RA) may have treatment delayed until typical phenotypic features accumulate. Due to the concern for toxicities of DMARDs, patients are often treated with NSAIDs and simple analgesics during this period. However, delay in DMARD treatment in early RA has been shown to result in poorer outcomes, such as irreversible radiographic damage.