Date of Award


Document Type

Restricted Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)


Physician Assistant Studies

First Advisor

Skye Peltier


Background: Rheumatoid arthritis (RA) is an autoimmune disease which mainly affects synovial tissue of joints, but has systemic ramifications for those diagnosed. In RA, much of the mortality and morbidity is caused by cardiovascular disease (CVD). Research has suggested that medications used to treat RA disease progression, such as methotrexate (MTX), a non-biologic disease modifying anti-rheumatic drug (DMARD) and TNF-ɑ inhibitors, a class of biologic DMARDs, are associated with a decreased risk of CVD. The main objective of this review was to investigate whether the use of MTX is associated with a reduced risk of mortality and morbidity caused by CVD in comparison to concurrent treatment with TNF-ɑ inhibitors in patients with RA.

Methods: To investigate this question, the following databases were used: Google Scholar, PubMed, and the Augsburg University Lindell Library Search tool. Each research article obtained was read and analyzed for relatedness to the proposed question and evaluated for methodology and quality.

Findings: Research suggests that RA is associated with an increased risk of CVD. In terms of medications, prompt treatment with MTX not only reduces disease activity, but is also associated with a reduced risk of CVD. The addition of TNF-ɑ inhibitors to RA treatment suggest a promising effect on decreasing CVD risk, but more research is needed to confirm the strength of this effect and evaluate the risk of their use.

Interpretation: The literature supports prompt initial treatment with two DMARDs, MTX and concurrent use of a TNF-ɑ inhibitor, may result in improved CVD outcomes in comparison to standard monotherapy treatment alone in patients diagnosed with RA.