Cholesterol and RA

During the early stages of rheumatoid arthritis (RA), cholesterol levels shift and can start causing plaque to build up in the arteries, suggest study findings published in the Annals of Rheumatic Disease (September 2003). Patients with RA often have levels of total cholesterol that are actually slightly below normal, noted the researchers.

The problem is that high-density lipoprotein (HDL, or ?good?) cholesterol is decreased to a greater extent than is the total level of cholesterol. Therefore, the ratio of total cholesterol to HDL, known as the ?atherogenic index,? is usually >4, which raises the risk of atherosclerosis.

The study included 47 participants with early active RA, 112 with long-standing RA, and 134 patients who were enrolled in a trial comparing treatment with sulfasalazine for RA with a combination regimen containing steroids. The researchers found that patients with established RA had total cholesterol levels that were slightly higher, compared with patients with early RA, who had total cholesterol levels that were on the low side of normal. All of the participants had HDL cholesterol levels that were below normal, and the lowest atherogenic index at the start of the study was 5.1.

As for the participants in the treatment trial, both treatment groups showed an improvement in the atherogenic index. Steroidcontaining therapy produced a much more rapid improvement, compared with sulfasalazine. In the long run, however, harmful cardiovascular effects from steroids (eg, increased blood pressure and insulin resistance) would probably offset the improvement in atherosclerosis risk, the study authors said.