Despite a growing body of evidence suggesting that the inflammation that is a hallmark of rheumatoid arthritis (RA) increases a patient's risk of myocardial infarction or stroke, RA patients are less likely to take prophylactic aspirin than RA-free controls, according to new research¹ presented at the 69th Annual Meeting of the American College of Rheumatology in San Diego, California.

These findings call attention to the need for rheumatologists to ensure that RA patients are receiving proper prophylactic care for cardiovascular disease.

Overall, RA patients were more likely to have a heart attack, but less likely to be taking prophylactic aspirin than controls with noninflammatory rheumatic disorders, the study found. Slightly more than 18% of RA patients took prophylactic aspirin, compared with 26% of the study participants with noninflammatory rheumatic diseases.

While the new study doesn't come up with any answers regarding the discrepancy, "it highlights the possibility that RA patients are not taking aspirin and calls for more studies," says lead researcher Lee Colglazier, MD, a rheumatologist in Crestview Hills, Kentucky. Dr. Colglazier joined the study as a rheumatology fellow at Wake Forest University School of Medicine in Winston-Salem, North Carolina. "Rheumatologists need to recognize this is a very high-risk group who may not be receiving appropriate treatment," he says.

The three-year study utilized the National Data Bank for Rheumatic Diseases from Wichita, Kansas. The cohort comprised more than 18,000 patients with RA or noninflammatory rheumatic diseases such as osteoarthritis (OA). Specifically, 14,114 participants had RA and 4009 had noninflammatory rheumatic disorders. Patients were surveyed regarding their use of prophylactic aspirin, which was defined as 81 mg to 325 mg per day.

Among RA patients, men were more likely to use aspirin than women. Use of cyclooxygenase (COX)-2 inhibitors was associated with greater aspirin use, as was majority ethnic status and more years of education, the study showed. Nonspecific nonsteroidal anti-inflammatory drug (NSAID) use was associated with less aspirin, as was poorer functional status, increased pain, fibromyalgia, and the use of prednisone, the study found.

Disconnect between rheumatologists and primary-care physicians

While RA patients were less likely to take prophylactic aspirin, the study did not identify any clinical, demographic, or treatment variables to explain the lack of aspirin use. However, "it may be that rheumatologists, in tune with the cardiovascular risk RA poses, are assuming preventative issues are being addressed by the primary physician, whereas primary-care physicians may not be aware that those with RA are under additional cardiac risk that may warrant aspirin use," Dr. Colglazier suggests.

"Alternatively," he says, "treating physicians may believe complicated therapies weigh against the additional low-dose aspirin, or patients themselves may be discouraged by warnings against using aspirin with medications they are already taking." For example, package inserts and pharmacists recommend against using aspirin with methotrexate or NSAIDs.

Still, Dr. Colglazier stresses, "Whatever the cause, rheumatologists should make sure that their patients are receiving the recommended care for the prevention and treatment of cardiovascular disorders."

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