CONCISE REPORTS EVect of disease modifying agents on the lipid profiles of patients with rheumatoid arthritis

Objective—To determine the eVect of intramuscular gold and oral hydroxychloroquine(HCQ) on the lipid profile of patients with rheumatoid arthritis (RA). Method—A prospective randomised clinical trial of 12 months’ duration was performed in 100 RA patients. Data on clinical and laboratory parameters of disease activity, and fasting serum lipid samples was collected at baseline and at three monthly intervals over one year. Results—The expected second line response was seen with no significant diVerence in eYcacy between the groups at 12 months. The HCQ group had a significant overall improvement in their lipid profile while there was a trend for lipid profiles in the gold group to worsen. Conclusions—HCQ is an eVective second line agent that has beneficial eVects on serum lipids. This should be taken into account when choosing a disease modifying anti-rheumatic drug in patients who suVer from RA and who have significant cardiovascular risk factors. (Ann Rheum Dis 1997;56:374–377) Rheumatoid arthritis (RA) patients die earlier than the general population and part of this increased mortality results from atherosclerotic coronary artery disease. 3 Serum lipid concentrations are predictive for the development of atherosclerosis: men with cholesterol in the highest fifth of the population range have 3.5 times the risk of ischaemic heart disease (IHD) compared with those in the lowest fifth. The ratio of high density lipoprotein (HDL) to total cholesterol is an even stronger predictor of risk. Patients with active RA have abnormal lipid profiles as evidenced by a global reduction of all lipid subsets and also increased triglyceride concentrations during active disease. There is some evidence that controlling disease activity may reverse some of these changes. We studied the eVect of two disease modifying agents on lipid profiles in RA. Hydroxychloroquine (HCL) was chosen as previous reports have suggested that it may have beneficial eVects on lipid metabolism independent of any changes resulting from its second line eVect. Intramuscular gold has no reported direct influence on lipid profiles and was used as a comparative agent as any changes seen could be assumed to result from changed disease activity.