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Hydroxychloroquine for RA Boosts Metabolic, Cardiovascular Profile

Hydroxychloroquine for RA Boosts Metabolic, Cardiovascular Profile

In patients with rheumatoid arthritis, hydroxychloroquine decreases modifiable risk factors for cardiovascular disease, including lipid profile, diabetes incidence, and glycosylated hemoglobin levels.

Hydroxychloroquine reduces the incidence of cardiovascular events but has only a moderate effect on RA disease progression and disease activity and is not used as monotherapy.

Patients with rheumatoid arthritis are at higher risk for cardiovascular disease and death compared with the general population. Hydroxychloroquine has been shown to improve survival rates in other inflammatory diseases, such as systemic lupus erythematosus.

As a treatment for rheumatoid arthritis, hydroxychloroquine has a modest effect, but it can be used in combination therapy and may act synergistically with methotrexate.

Claire Rempenault and fellow researchers in France sought to uncover the impact of hydroxychloroquine on the metabolic profile and incidence of cardiovascular disease in patients with rheumatoid arthritis. They presented their findings in a recent Annals of the Rheumatic Diseases article.

The study

The authors conducted a systematic review and meta-analysis of the literature to look at hydroxychloroquine and rheumatoid arthritis.

Ultimately, 16 studies were included in the systematic review and 9 studies in the meta-analysis for lipid rates and diabetes incidence.

The results

• Lipid profiles were better in hydroxychloroquine patients; total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), and triglycerides (TG) were −9.8 mg/dL (95% confidence interval [CI], −14.0 to −5.6); −0.25 mmol/L, −10.6 mg/dL (95% CI, −14.2 to −7.0); +4.1 mg/dL (2.2; 6.0) (+0.10 mmol/L); and −19.1 mg/dL (95% CI, −27.2 to −11.1), respectively.

• After initiation of hydroxychloroquine, the average decrease in level of TC, LDL, and TG was −13.1 mg/dL (95% CI, −20.9 to −5.3) (−0.34 mmol/L); −12.3 mg/dL (95% CI, −20.2 to −4.6) (−0.32 mmol/L); and −12.5 mg/dL (95% CI, −28.9 to 3.9) (−0.14 mmol/L), respectively, and mean increase in HDL level was 1.6 mg/dL (95% CI, −0.96 to 4.3) (+0.04 mmol/L).

• The incidence of diabetes was lower in patients with rheumatoid arthritis who were receiving hydroxychloroquine than in those who were not (pooled hazard ratio, 0.59 [95% CI, 0.49 to 0.70]).

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