AB0266 METHOTREXATE AND CARDIOVASCULAR RISK IN RHEUMATIC DISEASES:A COMPREHENSIVE REVIEW

Background: The management of inflammatory rheumatic disease has evolved in the last decade with the importance of the management of comorbidities. Methotrexate is the cornerstone of inflammatory rheumatic disease management, but its cardiovascular effects are still poorly understood Objectives: To assess the cardiovascular impact of methotrexate in inflammatory rheumatic disease. Methods: A systematic review of the literature, following the prisma recommandations, was performed on the PubMed and Embase databases with the following keywords: (“Methotrexate”) AND (“cardiovascular”). We included papers written in English and including patients older than 18 years. Results: 570 references were identified and, 36 articles were kept for analysis. The mechanism of action of methotrexate lies mainly on the antagonism of purines. It reduces systemic inflammation, oxidative stress. In Rheumatoid arthritis, the use of methotrexate was associated with a decreased incidence of high blood pressure, an improvement of the lipid profile and of the insulin resistance. Major adverse cardiovascular events were decreased with methotrexate. The effects of methotrexate on the endothelial function were more controversial and available data did not argue for a direct vascular effect of MTX in RA. In psoriatic arthritis, evidences were more scarce. A meta-analysis showed that methotrexate was associated with a reduction of cardiovascular events in patients with psoriatic arththritis. In psoriatic arthritis, methotrexate did not improve the endothelial function. In plaque psoriasis, available data were rare. The use of methotrexate in this condition was not associated with a reduction of cardiovascular events. Nevertheless, a decrease in circulating VCAM-1 and in E selectin levels was described with the use of methotrexate. In HIV infection, a model of pro inflammatory state, the use of methotrexate did not change the endothelial function and thus the cardiovascular events. Finally, in general population, the use of methotrexate did not decrease the occurrence of cardiovascular events after a myocardial infarction. Conclusion: The cardiovascular effects of methotrexate are poorly understood at this time. Nevertheless, it seems clear that methotrexate can reduce the occurrence of cardiovascular events in inflammatory disease. The mechanisms explaining this good issue are poorly understood, but it seems possible that the essential effect of methotrexate lies in the reduction of the inflammatory syndrome without a direct vascular impact. Disclosure of Interests: None declared