类风湿性关节炎的心脏保护剂：TNF抑制剂+甲氨喋呤

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TNF Inhibitor/Methotrexate Combo Cardioprotective in RA
By Megan Rauscher
NEW YORK (Reuters Health) Nov 08 - The combination of methotrexate and a tumor necrosis factor (TNF)-inhibitor reduces by 80% the risk of acute myocardial infarction in patients with rheumatoid arthritis, according to research reported at the annual meeting of the American College of Rheumatology in Boston this week.

In a telephone interview with Reuters Health, study presenter Dr. Gurkirpal Singh noted that \"the number one reason for excess mortality in patients with rheumatoid arthritis is heart attacks. We believe that heart attacks in rheumatoid arthritis are caused by systemic inflammation throughout the body.\"

\"We show,\" Dr. Singh continued, \"that by suppressing systemic inflammation strongly with a combination of TNF inhibitor-methotrexate therapy, you see strong beneficial positive effects on inflammation not only in the joints but in the coronary arteries, presumably, which leads to lower heart attacks and deaths from heart attacks.\"

Using data from MediCal, California's Medicaid program, Dr. Singh from Stanford University School of Medicine in Palo Alto and colleagues identified 19,233 RA patients who were treated with a TNF-inhibitor (n = 4,943), methotrexate (n = 13,383), or other disease-modifying antirheumatic drugs (DMARDs; n = 14,958).

During 74,006 person-years of follow-up, 441 patients experienced myocardial infarction.

Data analysis showed that patients taking a TNF-inhibitor plus methotrexate had a multivariate-adjusted relative risk of acute myocardial infarction of 0.20 compared with patients taking methotrexate alone.

There was no statistical difference in risk of acute MI among patients taking a TNF-inhibitor alone, a TNF-inhibitor with other DMARDs, other DMARDs without methotrexate, or a combination of a DMARD and methotrexate, when compared with methotrexate alone, Dr. Singh and colleagues report.

This study shows that TNF-inhibitor therapy in combination with methotrexate \"dramatically reduces\" the risk of acute myocardial infarction in RA patients and \"should be seriously considered,\" particularly in those patients at high risk for myocardial infarction, Dr. Singh said.
本周在波士顿召开的美国风湿病学会年会上发表的一项研究显示，联合使用甲氨喋呤和一种肿瘤坏死因子（TNF）抑制剂能够使类风湿关节炎患者罹患心肌梗死的危险性下降80%。