de Groot Lodewijk, Jager Nynke A, Westra Johanna, Smit Andries J, Kallenberg Cees G M, Posthumus Marcel D, Bijl Marc
Department of Rheumatology and Clinical Immunology, Vascular Disease, University Medical Centre, University of Groningen and Department of Internal Medicine and Rheumatology, Martini Hospital, Groningen, The Netherlands
Department of Rheumatology and Clinical Immunology, Vascular Disease, University Medical Centre, University of Groningen and Department of Internal Medicine and Rheumatology, Martini Hospital, Groningen, The Netherlands.
Rheumatology (Oxford). 2015 Jul;54(7):1257-61. doi: 10.1093/rheumatology/keu459. Epub 2015 Jan 12.
The incidence of cardiovascular disease (CVD) is increased in RA. This study was designed to evaluate whether a reduction in disease activity influences early markers of CVD.
In a prospective longitudinal study, 58 newly diagnosed RA patients and 58 age- and sex-matched healthy controls (HCs) were included. Endothelial dysfunction was measured by small artery elasticity (SAE) and endothelial cell activation was assessed by measuring soluble vascular cellular activation molecule 1(sVCAM-1) and von Willebrand factor (vWF). Advanced glycation end products (AGEs) were quantified by skin autofluorescence. After 1 year, measurements were repeated in all RA patients.
At entry, SAE was decreased in RA vs HCs [median 3.4 ml/mmHg100 (range 1.2-9.0) vs 6.1 (range 5.0-15.3), P < 0.0001] and sVCAM-1 and vWF were increased: 391 ng/ml (range 256-680) vs 341 (range 223-691) (P = 0.0015) and 120 ng/ml (range 26.5-342) vs 99 (range 22-298) (P = 0.02), respectively. SAE was inversely correlated with the 28-joint DAS (DAS28; r = -0.31, P = 0.016). AGEs were increased by 2.55 arbitrary units (range 1.29-4.65) vs 2.12 (range 1.32-3.82) in HCs (P = 0.003). In multivariate analysis, the presence of RA, age and systolic blood pressure were independently and inversely related to SAE. After 1 year, SAE had significantly improved in RA, from 3.4 (range 1.2-9.0) to 3.8 (range 1.5-10.3) (P = 0.03).
Endothelial dysfunction is present in newly diagnosed RA patients, independently of traditional risk factors and is inversely correlated with disease activity. By reducing disease activity, endothelial dysfunction improves, although not to normal values. Also, a reduction in disease activity targeting traditional risk factors remains important in preventing CVD in RA.
类风湿关节炎（RA）患者心血管疾病（CVD）的发病率升高。本研究旨在评估疾病活动度降低是否会影响CVD的早期标志物。
在一项前瞻性纵向研究中，纳入了58例新诊断的RA患者和58例年龄及性别匹配的健康对照者（HCs）。通过小动脉弹性（SAE）测量内皮功能障碍，并通过测量可溶性血管细胞黏附分子1（sVCAM-1）和血管性血友病因子（vWF）评估内皮细胞活化。通过皮肤自发荧光对晚期糖基化终产物（AGEs）进行定量。1年后，对所有RA患者重复进行测量。
入组时，与HCs相比，RA患者的SAE降低[中位数3.4 ml/mmHg100（范围1.2 - 9.0）vs 6.1（范围5.0 - 15.3），P < 0.0001]，sVCAM-1和vWF升高：分别为391 ng/ml（范围256 - 680）vs 341（范围223 - 691）（P = 0.0015）和120 ng/ml（范围26.5 - 342）vs 99（范围22 - 298）（P = 0.02）。SAE与28关节疾病活动评分（DAS28）呈负相关（r = -0.31，P = 0.016）。与HCs相比，RA患者的AGEs增加了2.55个任意单位（范围1.29 - 4.65）vs 2.12（范围1.32 - 3.82）（P = 0.003）。多因素分析显示，RA的存在、年龄和收缩压与SAE独立且呈负相关。1年后，RA患者的SAE显著改善，从3.4（范围1.2 - 9.0）升至3.8（范围1.5 - 10.3）（P = 0.03）。
新诊断的RA患者存在内皮功能障碍，独立于传统危险因素，且与疾病活动度呈负相关。通过降低疾病活动度，内皮功能障碍有所改善，尽管未恢复至正常水平。此外，针对传统危险因素降低疾病活动度在预防RA患者的CVD方面仍然很重要。
