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DOI

  • Aamer Sandoo
    Department of Rheumatology, Dudley Group of Hospitals NHS Foundation Trust, Russells Hall Hospital, Pensnett Road, Dudley, West Midlands, DY1 2HQ, United Kingdom. aamer.sandoo@dgh.nhs.uk
  • George D Kitas
  • Douglas Carroll
  • Jet J C S Veldhuijzen van Zanten

INTRODUCTION: Rheumatoid arthritis (RA) is associated with an increased risk for cardiovascular disease (CVD), and it has been postulated that RA disease-related inflammation contributes to endothelial dysfunction. The aim of the present work was to examine predictors (RA-related and CVD risk factors) and anti-tumor necrosis factor-alpha (anti-TNF-α) treatment effects on endothelial function in different vascular beds.

METHODS: Microvascular endothelial function (laser Doppler imaging with iontophoresis of acetylcholine and sodium-nitroprusside), and macrovascular endothelial function (flow-mediated dilatation and glyceryl-trinitrate-mediated dilatation) were analyzed in parallel with disease activity. Individual CVD risk factors and global CVD risk were assessed cross-sectionally in 99 unselected RA patients and longitudinally (baseline, 2 weeks, and 3 months) in 23 RA patients commencing anti-TNF-α therapy.

RESULTS: In this cross-sectional study, regression analyses revealed that markers of RA disease-related inflammation were not associated with microvascular or macrovascular endothelium-dependent function (P > 0.05); global CVD risk inversely correlated with microvascular endothelium-dependent function (P < 0.01) and with macrovascular endothelium-independent function (P < 0.01). In the longitudinal study, only microvascular endothelium-dependent function showed an improvement after 2 weeks of anti-TNF-α treatment when compared with baseline (437% ± 247% versus 319% ± 217%; P = 0.001), but no association was evident between change in endothelial function and change in inflammatory markers.

CONCLUSIONS: Classical CVD risk may influence endothelial function more than disease-related markers of inflammation in RA. Classical CVD risk factors and anti-TNF-α medication have different effects on microvascular and macrovascular endothelial function, suggesting that combined CVD-prevention approaches may be necessary. Prospective studies examining whether assessments of vascular function are predictive of long-term CV outcomes in RA are required.

Keywords

  • Adalimumab, Antibodies, Monoclonal, Antibodies, Monoclonal, Humanized, Antirheumatic Agents, Arthritis, Rheumatoid, Cardiovascular Diseases, Cross-Sectional Studies, Endothelium, Vascular, Etanercept, Female, Humans, Immunoglobulin G, Inflammation, Infliximab, Laser-Doppler Flowmetry, Longitudinal Studies, Male, Middle Aged, Receptors, Tumor Necrosis Factor, Risk Factors, Clinical Trial, Journal Article
Original languageEnglish
Pages (from-to)R117
JournalArthritis Research & Therapy
Volume14
Issue number3
DOIs
Publication statusPublished - 17 May 2012
Externally publishedYes
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