Amsterdam Rheumatology and immunology Center, location Reade, Department of Rheumatology, Dr. Jan van Breemstraat 2, PO box 58271, 1040 HG Amsterdam, the Netherlands; Amsterdam Rheumatology and immunology Center, location Amsterdam UMC, VU University Medical Center, Department of Rheumatology, Amsterdam, the Netherlands.
Amsterdam Rheumatology and immunology Center, location Reade, Department of Rheumatology, Dr. Jan van Breemstraat 2, PO box 58271, 1040 HG Amsterdam, the Netherlands; Amsterdam Rheumatology and immunology Center, location Amsterdam UMC, VU University Medical Center, Department of Rheumatology, Amsterdam, the Netherlands.
Semin Arthritis Rheum. 2021 Apr;51(2):457-463. doi: 10.1016/j.semarthrit.2021.03.008. Epub 2021 Mar 17.
Rheumatoid arthritis (RA) patients have an increased risk of cardiovascular disease (CVD), partly due to an increased prevalence of cardiovascular risk factors, but also due to chronic systemic inflammation inducing atherosclerotic changes of the arterial wall. The aim of this study was to determine whether anti-inflammatory therapy for the treatment of RA has favorable effects on arterial wall inflammation in RA patients.
Arterial wall inflammation before and after 6 months of anti-inflammatory treatment was assessed in 49 early and established RA patients using 18F-fluorodeoxyglucose-positron emission tomography with computed tomography (18F-FDG-PET/CT). Arterial 18F-FDG uptake was quantified as maximum standardized uptake value (SUVmax) in the thoracic aorta, abdominal aorta, carotid, iliac and femoral arteries. Early RA patients (n = 26) were treated with conventional synthetic disease modifying anti-rheumatic drugs with or without corticosteroids, whereas established RA patients (n = 23) were treated with adalimumab.
In RA patients, overall SUVmax was over time reduced by 4% (difference -0.06, 95%CI -0.12 to -0.01, p = 0.02), with largest reductions in carotid (-8%, p = 0.001) and femoral arteries (-7%, p = 0.005). There was no difference in arterial wall inflammation change between early and established RA patients (SUVmax difference 0.003, 95%CI -0.11 to 0.12, p = 0.95). Change in arterial wall inflammation significantly correlated with change in serological inflammatory markers (erythrocyte sedimentation rate and C-reactive protein).
Arterial wall inflammation in RA patients is reduced by anti-inflammatory treatment and this reduction correlates with reductions of serological inflammatory markers. These results suggest that anti-inflammatory treatment of RA has favorable effects on the risk of cardiovascular events in RA patients.
类风湿关节炎（RA）患者发生心血管疾病（CVD）的风险增加，部分原因是心血管危险因素的患病率增加，但也与慢性系统性炎症引起动脉壁粥样硬化改变有关。本研究旨在确定针对 RA 的抗炎治疗是否对 RA 患者的动脉壁炎症有有利影响。
49 例早期和确诊的 RA 患者接受了 6 个月的抗炎治疗，使用 18F-氟脱氧葡萄糖正电子发射断层扫描与计算机断层扫描（18F-FDG-PET/CT）评估治疗前后动脉壁炎症。胸主动脉、腹主动脉、颈动脉、髂动脉和股动脉的 18F-FDG 摄取量用最大标准化摄取值（SUVmax）表示。26 例早期 RA 患者接受了常规合成的疾病修饰抗风湿药物（csDMARDs）联合或不联合皮质类固醇治疗，23 例确诊 RA 患者接受了阿达木单抗治疗。
RA 患者的 SUVmax 总体呈时间依赖性下降 4%（差值-0.06，95%CI-0.12 至-0.01，p=0.02），颈动脉（-8%，p=0.001）和股动脉（-7%，p=0.005）的降幅最大。早期和确诊 RA 患者的动脉壁炎症变化无差异（SUVmax 差值 0.003，95%CI-0.11 至 0.12，p=0.95）。动脉壁炎症的变化与血清炎症标志物（红细胞沉降率和 C 反应蛋白）的变化显著相关。
抗炎治疗可降低 RA 患者的动脉壁炎症，这种降低与血清炎症标志物的降低相关。这些结果表明，针对 RA 的抗炎治疗对 RA 患者的心血管事件风险有有利影响。
