Untangling the lipid paradox in rheumatoid arthritis
Cardiovascular disease (CVD) is a major cause of mortality in people with rheumatoid arthritis (RA) – a long-term autoimmune disorder that causes pain, swelling, and stiffness in the joints. People with RA have around a 50% higher cardiovascular risk than those in the general population.
Given that dyslipidemia plays a central role in CVD, it might be expected that RA patients would therefore have a high-risk lipid profile, involving raised total cholesterol and low-density lipoprotein-cholesterol (LDL-C).
But, in recent years it has become evident that the opposite is actually the case. Patients with RA in fact have a lipid profile characterized by reduced total cholesterol, LDL-C and high-density lipoprotein-cholesterol (HDL-C). Such a lipid profile is normally associated with a protective effect against CVD. Furthermore, successful treatment in RA has previously been found to result in increased lipid levels. So what are the reasons for this so-called “lipid paradox”?