Annelies B Blanken1,2, Reinder Raadsen3, Rabia Agca3,4, Alper M van Sijl3,4, Yvo M Smulders5, Michael T Nurmohamed3,4. 1. Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, PO box 58271, 1040 HG, Amsterdam, the Netherlands. a.blanken@reade.nl. 2. Amsterdam Rheumatology and Immunology Center, Location Amsterdam UMC, Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands. a.blanken@reade.nl. 3. Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, PO box 58271, 1040 HG, Amsterdam, the Netherlands. 4. Amsterdam Rheumatology and Immunology Center, Location Amsterdam UMC, Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands. 5. Amsterdam UMC, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Abstract
OBJECTIVE: To assess the effect of 4 years of anti-inflammatory therapy on markers of subclinical vascular disease in rheumatoid arthritis patients. METHODS: Carotid intima media thickness (IMT), augmentation index (AIx@75) and pulse wave velocity (PWV) measurements were performed repeatedly in 61 RA patients (30 early RA starting with csDMARDs and 31 established RA starting with adalimumab) for 4 years. These markers were also measured in 29 controls with osteoarthritis at baseline (BL). RESULTS: IMT and AIx@75 at BL were higher in RA compared to OA, while PWV was higher in OA. In RA patients, AIx@75 and PWV decreased in the first 6 months after starting anti-inflammatory therapy. At 48 M, the level of AIx@75 remained lower than before therapy, while PWV at 48 M was comparable to BL (AIx@75: BL 28% (95% confidence interval 25-30%), 6 M 23% (20-26%), 48 M 25% (22-28%); PWV: BL 8.5 (7.8-9.2), 6 M 8.0 (7.1-8.9), 48 M 8.6 (7.6-9.6) m/s). IMT remained stable. There was an effect of disease activity (longitudinally, adjusted for changes over time) on IMT, AIx@75 and PWV. CONCLUSION: This study suggests modest beneficial changes in some surrogate markers of subclinical vascular disease after anti-inflammatory therapy. These changes were associated with improvement in disease activity markers. Whether or not these beneficial changes ultimately predict a reduction in clinicalcardiovascular endpoints remains to be established in prospective studies.
OBJECTIVE: To assess the effect of 4 years of anti-inflammatory therapy on markers of subclinical vascular disease in rheumatoid arthritis patients. METHODS: Carotid intima media thickness (IMT), augmentation index (AIx@75) and pulse wave velocity (PWV) measurements were performed repeatedly in 61 RA patients (30 early RA starting with csDMARDs and 31 established RA starting with adalimumab) for 4 years. These markers were also measured in 29 controls with osteoarthritis at baseline (BL). RESULTS: IMT and AIx@75 at BL were higher in RA compared to OA, while PWV was higher in OA. In RA patients, AIx@75 and PWV decreased in the first 6 months after starting anti-inflammatory therapy. At 48 M, the level of AIx@75 remained lower than before therapy, while PWV at 48 M was comparable to BL (AIx@75: BL 28% (95% confidence interval 25-30%), 6 M 23% (20-26%), 48 M 25% (22-28%); PWV: BL 8.5 (7.8-9.2), 6 M 8.0 (7.1-8.9), 48 M 8.6 (7.6-9.6) m/s). IMT remained stable. There was an effect of disease activity (longitudinally, adjusted for changes over time) on IMT, AIx@75 and PWV. CONCLUSION: This study suggests modest beneficial changes in some surrogate markers of subclinical vascular disease after anti-inflammatory therapy. These changes were associated with improvement in disease activity markers. Whether or not these beneficial changes ultimately predict a reduction in clinicalcardiovascular endpoints remains to be established in prospective studies.
Authors: Lennart T H Jacobsson; Carl Turesson; Anders Gülfe; Meliha C Kapetanovic; Ingemar F Petersson; Tore Saxne; Pierre Geborek Journal: J Rheumatol Date: 2005-07 Impact factor: 4.666
Authors: V P van Halm; M J L Peters; A E Voskuyl; M Boers; W F Lems; M Visser; C D A Stehouwer; A M W Spijkerman; J M Dekker; G Nijpels; R J Heine; L M Bouter; Y M Smulders; B A C Dijkmans; M T Nurmohamed Journal: Ann Rheum Dis Date: 2008-08-12 Impact factor: 19.103
Authors: Sarah K Heathfield; Benjamin Parker; Leo A H Zeef; Ian N Bruce; M Yvonne Alexander Journal: Clin Exp Rheumatol Date: 2012-12-13 Impact factor: 4.473
Authors: Vokko P van Halm; Michael T Nurmohamed; Jos W R Twisk; Ben A C Dijkmans; Alexandre E Voskuyl Journal: Arthritis Res Ther Date: 2006 Impact factor: 5.156