Vascular effects of biologic agents in RA and spondyloarthropathies.

Endothelial dysfunction and accelerated atherosclerosis lead to increased cardiovascular morbidity and mortality in patients with rheumatoid arthritis and other inflammatory rheumatic diseases. Sustained inflammation is a major risk factor for cardiovascular disease. Apart from traditional vasculoprotective agents, biologic agents may also exert favorable effects on the vasculature. Indeed, agents that inhibit tumor necrosis factor (TNF) seem to transiently improve endothelial function. Data regarding the effects of biologic agents on atherosclerosis and arterial stiffness are inconsistent. The effects of the various TNF blockers on dyslipidemia might differ: long-term infliximab therapy could be pro-atherogenic, whereas some studies suggest that etanercept and adalimumab may exert beneficial effects on the lipid profile. TNF blockers have been shown to decrease the incidence of cardiovascular events in patients with rheumatoid arthritis. Preliminary data suggest that rituximab also improves endothelial function and dyslipidemia. Further studies are needed to determine the net effects of biologic agents on the vasculature.