Vassilopoulos Dimitrios, Gravos Athanasios, Vlachopoulos Charalambos, Kandili Anna, Ioakeimidis Nikolaos, Pectasides Dimitrios, Stefanadis Christodoulos
2nd Department of Medicine and Laboratory, Hippokration General Hospital, National University of Athens Medical School, 114 Vass. Sophias Ave., 115 27, Athens, Greece,
Clin Rheumatol. 2015 Feb;34(2):359-64. doi: 10.1007/s10067-014-2718-8. Epub 2014 Jun 15.
Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality attributed to traditional cardiovascular risk factors and/or the chronic systemic inflammation. We investigated the effect of a TNF antagonist (adalimumab-ADA) on aortic stiffness in RA patients. We studied 18 RA patients with active disease despite therapy with disease modifying antirheumatic drugs (DMARDs), treated with ADA (alone or in combination with DMARDs) for 12 weeks. Disease activity markers as well as aortic stiffness indices (carotid-femoral pulse wave velocity-PWV, augmentation index-AIx), were measured at baseline and at the end of treatment. Eighteen RA patients treated with methotrexate (MTX) were included as controls. Patients were categorized as responders (decrease of Disease Activity Score-DAS28 > 1.2) or nonresponders. There was a statistically significant decrease in PWV (from 8.18 ± 2.03 to 7.01 ± 1.78 m/s, p = 0.00006) and DAS28 (from 6.65 ± 1.22 to 4.69 ± 1.46, p = 0.00007) in RA patients treated with ADA. The decrease in PWV was observed both in responders (n = 12) and nonresponders (n = 6). Multivariate analysis showed that the decrease of PWV was independent of changes in disease activity or other parameters. There was no significant change in PWV in patients treated with MTX (from 8.87 ± 1.91 to 8.41 ± 2.17, p = 0.29). No significant change in AIx or traditional cardiovascular risk factors was observed. Treatment with ADA significantly reduced aortic stiffness in RA patients regardless of their response to therapy. These findings imply a direct protective effect of ADA in vascular wall in RA patients.
类风湿关节炎（RA）与归因于传统心血管危险因素和/或慢性全身炎症的心血管发病率和死亡率增加相关。我们研究了肿瘤坏死因子拮抗剂（阿达木单抗-ADA）对RA患者主动脉僵硬度的影响。我们研究了18例尽管接受了改善病情抗风湿药物（DMARDs）治疗但仍患有活动性疾病的RA患者，用ADA（单独或与DMARDs联合）治疗12周。在基线和治疗结束时测量疾病活动标志物以及主动脉僵硬度指标（颈股脉搏波速度-PWV、增强指数-AIx）。18例接受甲氨蝶呤（MTX）治疗的RA患者作为对照。患者被分类为反应者（疾病活动评分-DAS28降低>1.2）或无反应者。接受ADA治疗的RA患者的PWV（从8.18±2.03降至7.01±1.78 m/s，p=0.00006）和DAS28（从6.65±1.22降至4.69±1.46，p=0.00007）有统计学意义的降低。在反应者（n=12）和无反应者（n=6）中均观察到PWV降低。多变量分析表明，PWV的降低与疾病活动或其他参数的变化无关。接受MTX治疗的患者的PWV无显著变化（从8.87±1.91降至8.41±2.17，p=0.29）。未观察到AIx或传统心血管危险因素有显著变化。无论对治疗的反应如何，ADA治疗均显著降低了RA患者的主动脉僵硬度。这些发现表明ADA对RA患者血管壁有直接保护作用。
