Kerekes György, Soltész Pál, Szucs Gabriella, Szamosi Szilvia, Dér Henriett, Szabó Zoltán, Csáthy László, Váncsa Andrea, Szodoray Peter, Szegedi Gyula, Szekanecz Zoltán
Cardiovascular Unit, Third Department of Medicine, University of Debrecen Medical and Health Science Center, Debrecen, Hungary.
Isr Med Assoc J. 2011 Mar;13(3):147-52.
Increased cardiovascular morbidity has become a leading cause of mortality in rheumatoid arthritis (RA). Tumor necrosis factor-alpha (TNFa) inhibitors may influence flow-mediated vasodilation (FMD) of the brachial artery, common carotid intima-media thickness (ccIMT) and arterial stiffness indicated by pulse-wave velocity (PWV) in RA.
To assess the effects of adalimumab treatment on FMD, ccIMT and PWV in early RA.
Eight RA patients with a disease duration < or =1 year received 40 mg adalimumab subcutaneously every 2 weeks. Ultrasound was used to assess brachial FMD and ccIMT. PWV was determined by arteriograph. These parameters were correlated with C-reactive protein, vonWillebrand factor (vWF), immunoglobulin M (IgM)-rheumatoid factor (RF), anti-CCP levels and 28-joint disease activity score (DAS28).
Adalimumab therapy successfully ameliorated arthritis as it decreased CRP levels (P = 0.04) and DAS28 (P < 0.0001). Endothelial function (FMD) improved in comparison to baseline (P < 0.05). ccIMT decreased after 24 weeks, indicating a mean 11.9% significant improvement (P = 0.002). Adalimumab relieved arterial stiffness (PWV) after 24 weeks. Although plasma vWF levels decreased only non-significantly after 12 weeks of treatment, an inverse correlation was found between FMD and vWF (R = -0.643, P = 0.007). FMD also inversely correlated with CRP (R = -0.596, P= 0.015). CRP and vWF also correlated with each other (R = 0.598, P = 0.014). PWV and ccIMT showed a positive correlation (R = 0.735, P = 0.038).
Treatment with adalimumab exerted favorable effects on disease activity and endothelial dysfunction. It also ameliorated carotid atherosclerosis and arterial stiffness in patients with early RA. Early adalimumab therapy may have an important role in the prevention and management of vascular comorbidity in RA.
心血管疾病发病率增加已成为类风湿关节炎（RA）患者死亡的主要原因。肿瘤坏死因子-α（TNFα）抑制剂可能会影响RA患者肱动脉的血流介导的血管舒张（FMD）、颈总动脉内膜中层厚度（ccIMT）以及由脉搏波速度（PWV）表示的动脉僵硬度。
评估阿达木单抗治疗对早期RA患者FMD、ccIMT和PWV的影响。
8例病程≤1年的RA患者每2周皮下注射40mg阿达木单抗。采用超声评估肱动脉FMD和ccIMT。通过动脉造影测定PWV。将这些参数与C反应蛋白、血管性血友病因子（vWF）、免疫球蛋白M（IgM）-类风湿因子（RF）、抗环瓜氨酸肽（CCP）水平以及28个关节的疾病活动评分（DAS28）进行相关性分析。
阿达木单抗治疗成功改善了关节炎症状，降低了CRP水平（P = 0.04）和DAS28（P < 0.0001）。与基线相比，内皮功能（FMD）有所改善（P < 0.05）。24周后ccIMT降低，平均显著改善了11.9%（P = 0.002）。24周后阿达木单抗缓解了动脉僵硬度（PWV）。尽管治疗12周后血浆vWF水平仅略有下降，但FMD与vWF之间存在负相关（R = -0.643，P = 0.007）。FMD与CRP也呈负相关（R = -0.596，P = 0.015）。CRP与vWF之间也存在相关性（R = 0.598，P = 0.014）。PWV与ccIMT呈正相关（R = 0.735，P = 0.038）。
阿达木单抗治疗对疾病活动和内皮功能障碍产生了有益影响。它还改善了早期RA患者的颈动脉粥样硬化和动脉僵硬度。早期使用阿达木单抗治疗可能在RA血管合并症的预防和管理中发挥重要作用。
