Sustained improvement of vascular endothelial function during anti‐TNFα treatment in rheumatoid arthritis patients
- 1 January 2009
- journal article
- research article
- Published by Informa UK Limited in Scandinavian Journal of Rheumatology
- Vol. 38 (1), 6-10
- https://doi.org/10.1080/03009740802363768
Abstract
Vascular endothelial function and common carotid artery intima-medial thickness (CCA-IMT) are well-established surrogate markers for early atherosclerotic disease, which accounts for 30-40% of excess mortality in rheumatoid arthritis (RA) patients. Our aim was to investigate whether long-term treatment with anti-tumour necrosis factor (TNF)alpha agents can modulate endothelial function and CCA-IMT. Twelve patients with RA (mean age 54.8+/-15 years) on anti-TNFalpha treatment (seven adalimumab, five infliximab) due to uncontrolled disease activity, with mean Disease Activity Score (DAS28) 5.7 (range 4.6-6.9) despite disease-modifying anti-rheumatic drugs (DMARDs), were studied prospectively. Patients were assessed at baseline and after 3 and 18 months for endothelial-dependent vasodilatation, assessed by flow-mediated vasodilatation (FMD), endothelial-independent vasodilatation and CCA-IMT. RA disease activity and response to therapy were assessed by the DAS28 index. After 18 months of treatment, 67% of the patients were responders according to European League Against Rheumatism (EULAR) response criteria. Anti-TNFalpha treatment improved FMD (from 7+/-4.3% to 11.1+/-3.8%, p = 0.026) whereas CCA-IMT did not change significantly [from 0.67 (0.4-1) to 0.68 (0.39-1.2) mm; mean change 0.01 (-0.06 to 0.08) mm]. Endothelial-independent vasodilatation remained stable (20.4+/-7.3% to 22.9+/-6.5%, p = 0.4). In this small cohort of patients with RA and no clinically overt cardiovascular disease (CVD), after 18 months of treatment with anti-TNFalpha agents, endothelial function improved significantly while CCA-IMT remained stable. Longitudinal studies using more patients are needed to determine the clinical significance of these findings in relation to the risk of atherosclerosis.Keywords
This publication has 13 references indexed in Scilit:
- Reduction in the incidence of myocardial infarction in patients with rheumatoid arthritis who respond to anti–tumor necrosis factor α therapy: Results from the British Society for Rheumatology Biologics RegisterArthritis & Rheumatism, 2007
- Endothelial Cell Function During Atrial Fibrillation and After Restoration of Sinus RhythmThe American Journal of Cardiology, 2007
- Effect of anti–tumor necrosis factor α therapy on the progression of subclinical atherosclerosis in severe rheumatoid arthritisArthritis Care & Research, 2006
- Tumour necrosis factor antagonists improve disease activity but not arterial stiffness in rheumatoid arthritisRheumatology, 2005
- Effect of anti TNFalpha therapy on arterial diameter and wall shear stress and HDL cholesterolAtherosclerosis, 2004
- Active but transient improvement of endothelial function in rheumatoid arthritis patients undergoing long‐term treatment with anti–tumor necrosis factor α antibodyArthritis Care & Research, 2004
- Explaining How “High-Grade” Systemic Inflammation Accelerates Vascular Risk in Rheumatoid ArthritisCirculation, 2003
- Anti–Tumor Necrosis Factor-α Treatment Improves Endothelial Function in Patients With Rheumatoid ArthritisCirculation, 2002
- Research Methods in Human Cardiovascular Pharmacology edited by Dr S. Maxwell and Prof. D. Webb Flow‐mediated dilatationBritish Journal of Clinical Pharmacology, 2000
- Modified disease activity scores that include twenty-eight-joint counts development and validation in a prospective longitudinal study of patients with rheumatoid arthritisArthritis & Rheumatism, 1995