Sustained improvement of vascular endothelial function during anti-TNFα treatment in rheumatoid arthritis patients

• Published in: Scandinavian journal of rheumatology Vol. 38; no. 1; pp. 6 - 10
• Main Authors: Sidiropoulos, P. I., Siakka, P., Pagonidis, K., Raptopoulou, A., Kritikos, H., Tsetis, D., Boumpas, D. T.
• Format: Journal Article
• Language: English
• Published: Taylor & Francis 01.01.2009
• ISSN: 0300-9742; 1502-7732
• DOI: 10.1080/03009740802363768

Objectives: 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)α agents can modulate endothelial function and CCA-IMT. Methods: Twelve patients with RA (mean age 54.8±15 years) on anti-TNFα 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. Results: After 18 months of treatment, 67% of the patients were responders according to European League Against Rheumatism (EULAR) response criteria. Anti-TNFα 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). Conclusions: In this small cohort of patients with RA and no clinically overt cardiovascular disease (CVD), after 18 months of treatment with anti-TNFα 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.