Galarraga Bernat, Khan Faisel, Kumar Pradeep, Pullar Tom, Belch Jill J F
The Institute of Cardiovascular Research, Vascular and Inflammatory Diseases Research Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
Rheumatology (Oxford). 2009 Nov;48(11):1418-23. doi: 10.1093/rheumatology/kep251. Epub 2009 Sep 4.
Increased arterial stiffness, an independent risk factor for premature coronary artery disease, has been reported in patients with RA. The objectives of this study were first to assess, in patients with RA, the relationship between disease activity, inflammation and augmentation index, which is a combined measure of arterial stiffness and pulse wave reflection. The second objective was to establish any effect anti-rheumatic treatment may have on augmentation index.
One hundred and forty-eight RA patients with no previous history of cardiovascular disease (CVD) had their augmentation index corrected for a heart rate of 75 beats per minute (AIx@75), and parameters of RA disease activity and CV risk measured. Forty-seven patients were then treated with either MTX (n = 21) or etanercept (ETAN) (n = 26), and assessments were repeated at 2 and 4 months.
Patients with high CRP (> 10 mg/l) showed significantly higher mean AIx@75 than those with low CRP (< or = 10 mg/l) (33 +/- 8 vs 30 +/- 8%; P = 0.033). On regression analysis, log(10) CRP (beta = 0.298; P = 0.002), gender (beta = 0.257; P = 0.007), BMI (beta = -0.292; P = 0.004), diastolic blood pressure (beta = 0.260; P = 0.009) and age (beta = 0.194; P = 0.046) were independently associated with AIx@75. Treatment with ETAN (35 +/- 9, 32.5 +/- 1 and 32.5 +/- 8%; P = 0.025) but not MTX (31 +/- 1, 31 +/- 1 and 31 +/- 1%; P = 0.971) attenuated the AIx@75 significantly from baseline to Visits 2 and 3.
Systemic inflammation (CRP) is an independent predictor of arterial stiffness and pulse wave reflection in patients with RA. ETAN but not MTX therapy reduces arterial stiffness and pulse wave reflection and may thus improve CV morbidity in RA.
动脉僵硬度增加是早发冠状动脉疾病的一个独立危险因素，已有报道称类风湿关节炎（RA）患者存在这种情况。本研究的目的首先是评估RA患者的疾病活动度、炎症与增强指数之间的关系，增强指数是动脉僵硬度和脉搏波反射的综合指标。第二个目的是确定抗风湿治疗对增强指数可能产生的任何影响。
148例无心血管疾病（CVD）既往史的RA患者校正了心率为每分钟75次时的增强指数（AIx@75），并测量了RA疾病活动度和心血管风险参数。然后，47例患者接受甲氨蝶呤（MTX）（n = 21）或依那西普（ETAN）（n = 26）治疗，并在2个月和4个月时重复进行评估。
高CRP（> 10 mg/l）患者的平均AIx@75显著高于低CRP（≤ 10 mg/l）患者（33 ± 8 vs 30 ± 8%；P = 0.033）。回归分析显示，log(10)CRP（β = 0.298；P = 0.002）、性别（β = 0.257；P = 0.007）、体重指数（BMI）（β = -0.292；P = 0.004）、舒张压（β = 0.260；P = 0.009）和年龄（β = 0.194；P = 0.046）与AIx@75独立相关。从基线到第2次和第3次就诊时，ETAN治疗（35 ± 9、32.5 ± 1和32.5 ± 8%；P = 0.025）可使AIx@75显著降低，而MTX治疗（31 ± 1、31 ± 1和31 ± 1%；P = 0.971）则无此效果。
全身炎症（CRP）是RA患者动脉僵硬度和脉搏波反射的独立预测因素。ETAN治疗而非MTX治疗可降低动脉僵硬度和脉搏波反射，因此可能改善RA患者的心血管发病率。
