Exercise, TNFi Provide Differential Benefits for Cardiovascular Health in Rheumatoid Arthritis

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Tumor necrosis factor inhibitors and exercise provide different beneficial effects on cardiovascular health in patients with rheumatoid arthritis.

Tumor necrosis factor (TNF) inhibitors and exercise provide different beneficial effects on cardiovascular health and may provide the best protection against increased risk for cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA), according to a study published in Rheumatology International.  

Researchers examined the effects of TNF inhibitor therapy and exercise on CVD risk in patients with RA (n=43). Twenty-three patients (65% women; mean age, 54 years) initiated and completed 3 months of anti-TNF therapy, and 20 (70% women; mean age, 50 years) completed 3 months of an exercise intervention. Assessments for disease activity markers, vascular function, and CVD risk were conducted at baseline and after 3 months of treatment/intervention.

Both anti-TNF therapy and exercise improved patient fatigue and functional ability. Exercise-induced improvements in vascular function and reduced the overall risk for CVD (Framingham risk score, 5.50 at baseline and 4.05  at 3 months; =.049), but these same improvements were not seen with anti-TNF therapy.

Anti-TNF therapy was more successful than exercise at improving functional ability, pain, inflammation, and disease activity. Although most individual disease-related risk factors did improve with exercise, the only statistically significant improvements were seen in fatigue and functional ability (from 22.31 at baseline to 15.54 at 3 months for fatigue as assessed by the multidimensional assessment of fatigue, and from 1.41 to 1.27 for functional ability as assessed by the Stanford Health Assessment Questionnaire; =.071 and =.021, respectively).

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Study investigators conclude that as 2 of the most common obstacles to exercise cited by patients with RA are fatigue and functional ability, education about the benefits of exercise and support to overcome these obstacles will be needed to encourage this self-management strategy for reducing CVD risk. Furthermore, given the differing benefits of each approach, “the combination of exercise and anti-TNF treatment might provide the best protection for CVD in RA.”

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Veldhuijzen van Zanten JJCS, Sandoo A, Metsios GS, Stavropoulos-Kalinoglou A, Ntoumanis N, Kitas GD. Comparison of the effects of exercise and anti-TNF treatment on cardiovascular health in rheumatoid arthritis: results from two controlled trials [published online November 12, 2018]. Rheumatol Int. doi: 10.1007/s00296-018-4183-1