Cardioprotective mechanisms and efficacy of colchicine, methotrexate, hydroxychloroquine, sulfasalazine and leflunomide in inflammatory rheumatic and musculoskeletal diseases
Authors' conclusion
Cardiovascular benefit differs substantially between agents and is most convincing for colchicine in secondary prevention and for inflammation control with methotrexate in RA. Dedicated prospective trials in inflammatory RMD populations are needed before any csDMARD can be prescribed primarily for ASCVD prevention.
Study context
- Population
- Patients with inflammatory rheumatic and musculoskeletal diseases (RMDs)
- Outcome
- Colchicine and recurrent ASCVD events
Main finding
As reported in the abstract
- Strongest randomized evidence for reducing recurrent atherosclerotic cardiovascular disease (ASCVD) events in patients with established coronary disease, with supportive observational data in gout
Further findings
Methotrexate and cardiovascular events
- Associated with fewer cardiovascular events in rheumatoid arthritis (RA); CIRT trial neutral in patients without inflammatory arthritis
Hydroxychloroquine and cardiovascular risk
- Favorable lipid, glycaemic and antithrombotic effects and observational associations with lower cardiovascular risk in RA and systemic lupus erythematosus (SLE), but no definitive cardiovascular outcome trial
Sulfasalazine and leflunomide
- Evidence for sulfasalazine is limited and observational; human data for leflunomide are conflicting
Original publication
Cardioprotective mechanisms and efficacy of colchicine, methotrexate, hydroxychloroquine, sulfasalazine and leflunomide in inflammatory rheumatic and musculoskeletal diseases. Rheumatology (Oxford). Published 23 October 2026. doi:10.
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