Section of Rheumatology, 2nd Department of Medicine, General Hospital Linz, Krankenhausstr. 9, A-4020, Linz, Austria.
Clin Rheumatol. 2010 Jul;29(7):723-7. doi: 10.1007/s10067-010-1388-4. Epub 2010 Feb 17.
Premature atherosclerosis is linked to inflammation. Arterial stiffness is a marker of vascular dysfunction. We tested the hypothesis that treatment with infliximab, which is effective in reducing inflammation in rheumatoid arthritis (RA) and ankylosing spondylitis (AS), also lowers the augmentation index (AIx) in patients with active disease. We also analyzed the subendocardial viability ratio (SEVR), which is a measure of myocardial perfusion relative to cardiac workload. Included in the study were 30 patients (17 RA, 13 AS). Conventional treatment failed in all patients. The AIx and SEVR were determined by radial applanation tonometry before and after treatment with infliximab, at baseline and at week 7. After treatment with infliximab, Disease Activity Score for 28 joints (RA patients), Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index (AS patients), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) improved significantly (p < 0.001). The AIx for all patients increased from 22.0 +/- 14.0% to 24.6 +/- 13.0% (p = 0.03). The increase in the RA sub-group (p = 0.01) was also significant. The SEVR decreased from 148.6 +/- 23.7% to 141.2 +/- 23.7% (p = 0.04). Infliximab did not reduce the AIx in patients with RA and AS, although there were clinical improvements and CRP and ESR decreased. Instead, the AIx increased. This could negatively influence cardiac workload.
早发动脉粥样硬化与炎症有关。动脉僵硬度是血管功能障碍的标志物。我们检验了这样一个假设，即英夫利昔单抗（一种在类风湿关节炎和强直性脊柱炎中有效减少炎症的药物）的治疗也可以降低活动期疾病患者的增强指数（AIx）。我们还分析了心内膜下活力比（SEVR），这是衡量心肌灌注相对于心脏工作量的指标。研究纳入了 30 名患者（17 名类风湿关节炎患者，13 名强直性脊柱炎患者）。所有患者的常规治疗均失败。在接受英夫利昔单抗治疗前后，通过桡动脉平板张力测定法测定 AIx 和 SEVR，在基线和第 7 周进行测定。接受英夫利昔单抗治疗后，28 个关节疾病活动评分（类风湿关节炎患者）、Bath 强直性脊柱炎疾病活动指数、Bath 强直性脊柱炎功能指数（强直性脊柱炎患者）、红细胞沉降率（ESR）和 C 反应蛋白（CRP）均显著改善（p < 0.001）。所有患者的 AIx 从 22.0 ± 14.0%增加到 24.6 ± 13.0%（p = 0.03）。RA 亚组的增加也具有显著意义（p = 0.01）。SEVR 从 148.6 ± 23.7%降至 141.2 ± 23.7%（p = 0.04）。尽管临床改善，CRP 和 ESR 下降，但英夫利昔单抗并未降低 RA 和 AS 患者的 AIx。相反，AIx 增加了。这可能会对心脏工作量产生负面影响。
