Rheumatology Department, Gabriel Montpied Teaching Hospital, Place H. Dunant, Clermont-Ferrand 63000, France.
Rheumatology (Oxford). 2012 Jun;51(6):1107-11. doi: 10.1093/rheumatology/kes006. Epub 2012 Feb 10.
The excess cardiac risk, found in RA has been attributed to biological inflammation. Effective control of inflammation may be of benefit in reducing cardiovascular risk in RA patients. The aim of this study is to investigate the effects of 24 and 52 weeks of rituximab treatment on arterial stiffness and cardiovascular risk factors.
Arterial stiffness was measured by augmentation index (AIx) and pulse wave velocity (PWV), and other cardiovascular risk factors (lipid profile, blood pressure) were collected in active RA patients.
Thirty-three patients, of whom 29 were females, with a mean age of 60.9 (12.0) years were included. Thirty patients had positive RFs, 27 had positive anti-CCP antibody and 93.9% (n = 31) were erosive. Nineteen patients were non-responders to anti-TNF-α treatments. After rituximab treatment, no change was observed in arterial stiffness, neither after 6 nor after 12 months [PWV 8.1 (3.1) m/s at baseline, 8.1 (2.8) at 6 months, 8.0 (2.7) at 1 year, P = 0.924; and AIx 30.4 (8.2)% at baseline, 28.6 (7.6) at 6 months, 29.4 (6.7) at 1 year, P = 0.216]. Total and low-density lipoprotein cholesterol levels increased significantly but high-density lipoprotein (HDL) and triglyceride levels were unchanged. The atherogenic index (total cholesterol/HDL cholesterol) was increased, but not to a level of significance. No change was found in other cardiovascular risk factors. DAS-28 according to levels of ESR and CRP and biologic inflammation were significantly improved.
Arterial stiffness did not improve after 6 and 12 months of rituximab therapy. The treatment had a beneficial effect on biologic inflammation and disease activity, but caused a pro-atherogenic lipid profile.
类风湿关节炎（RA）患者存在心脏风险增加，这归因于生物炎症。有效控制炎症可能有益于降低 RA 患者的心血管风险。本研究旨在探讨利妥昔单抗治疗 24 周和 52 周对动脉僵硬度和心血管危险因素的影响。
通过脉搏波速度（PWV）和增强指数（AIx）测量动脉僵硬度，并收集 RA 活动患者的其他心血管危险因素（血脂谱、血压）。
共纳入 33 例患者，其中 29 例为女性，平均年龄 60.9（12.0）岁。30 例患者 RF 阳性，27 例抗 CCP 抗体阳性，93.9%（n=31）为侵蚀性。19 例患者对 TNF-α 治疗无反应。利妥昔单抗治疗后，6 个月和 12 个月时动脉僵硬度均无变化[PWV 基线 8.1（3.1）m/s，6 个月 8.1（2.8）m/s，1 年 8.0（2.7）m/s，P=0.924；AIx 基线 30.4（8.2）%，6 个月 28.6（7.6）%，1 年 29.4（6.7）%，P=0.216]。总胆固醇和低密度脂蛋白胆固醇水平显著升高，但高密度脂蛋白（HDL）和甘油三酯水平不变。致动脉粥样硬化指数（总胆固醇/HDL 胆固醇）升高，但无统计学意义。其他心血管危险因素无变化。DAS-28 根据 ESR 和 CRP 水平和生物炎症显著改善。
利妥昔单抗治疗 6 个月和 12 个月后，动脉僵硬度并未改善。该治疗对生物炎症和疾病活动有有益影响，但导致了动脉粥样硬化前的血脂谱。
