Mathieu Sylvain, Couderc Marion, Glace Baptiste, Pereira Bruno, Tournadre Anne, Dubost Jean-Jacques, Soubrier Martin
Department of Rheumatology, Gabriel-Montpied Hospital, Clermont-Ferrand, France ; Faculty of Medicine, University Clermont 1, Clermont-Ferrand, France.
Biologics. 2013;7:259-64. doi: 10.2147/BTT.S52003. Epub 2013 Dec 2.
Systemic inflammation plays an important role in the increased cardiac risk observed in rheumatoid arthritis (RA). Effective control of inflammation and disease activity may be of benefit in reducing cardiovascular risk in RA patients.
Our study was conducted in patients with active RA to investigate the effects of 24-week abatacept treatment on aortic stiffness measured by pulse wave velocity (PWV).
The study included 21 patients, of whom 17 were females, with a mean age of 65.2±13.7 years. Ten patients had positive rheumatoid factors, 16 positive anti-citrullinated protein antibodies, and 19 presented an erosive form of RA. Sixteen patients were nonresponders to anti-tumor necrosis factor-alpha treatments. After 6 months of abatacept treatment, there was a significant increase in PWV levels (9.8±2.9 versus 8.5±3.9 m/second; P=0.02). A nonsignificant increase in total cholesterol and low-density lipoprotein cholesterol was observed. There was also a significant increase in high-density lipoprotein cholesterol levels, which led to a nonsignificant decrease in atherogenic index. The improvement in disease activity was significant, and there was a decrease of systemic inflammatory parameters, but without reaching statistical significancy. Changes in PWV were significantly correlated with changes in Disease Activity Score on 28 joints based on erythrocyte sedimentation rate (r=0.46; P=0.035) and in high-density lipoprotein cholesterol (r=-0.38; P=0.046). No correlation was observed with changes in C-reactive protein and in other parameters of lipid profile or in steroid dose.
The worsening of aortic stiffness found after 6 months of abatacept therapy might be due to an insufficient decrease in systemic inflammation.
全身炎症在类风湿关节炎（RA）患者心脏风险增加中起重要作用。有效控制炎症和疾病活动可能有助于降低RA患者的心血管风险。
我们对活动期RA患者进行研究，以探讨阿巴西普治疗24周对通过脉搏波速度（PWV）测量的主动脉僵硬度的影响。
该研究纳入21例患者，其中17例为女性，平均年龄65.2±13.7岁。10例患者类风湿因子阳性，16例抗瓜氨酸化蛋白抗体阳性，19例表现为侵蚀性RA。16例患者对抗肿瘤坏死因子-α治疗无反应。阿巴西普治疗6个月后，PWV水平显著升高（9.8±2.9对8.5±3.9米/秒；P=0.02）。总胆固醇和低密度脂蛋白胆固醇有非显著性升高。高密度脂蛋白胆固醇水平也显著升高，导致致动脉粥样硬化指数非显著性降低。疾病活动度有显著改善，全身炎症参数有所下降，但未达到统计学显著性。PWV的变化与基于红细胞沉降率的28个关节疾病活动评分的变化显著相关（r=0.46；P=0.035），与高密度脂蛋白胆固醇的变化也显著相关（r=-0.38；P=0.046）。未观察到与C反应蛋白变化、其他血脂参数变化或类固醇剂量变化的相关性。
阿巴西普治疗6个月后发现主动脉僵硬度恶化可能是由于全身炎症的下降不足。
