Department of Internal Medicine, Rheumatology and Clinical Immunology, Faculty of Medicine in Katowice Medical University of Silesia, Katowice, Poland.
Department of Pathophysiology, Health Promotion and Obesity Management Unit, Faculty of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
Curr Pharm Des. 2022;28(24):2029-2037. doi: 10.2174/1381612828666220527141532.
Rheumatoid arthritis (RA) represents the most frequent form of inflammatory arthritis, affecting approximately 1% of the population worldwide. The introduction of novel therapeutic strategies targeting proinflammatory cytokines (TNF-α and interleukin-6) revolutionized the treatment of RA. This kind of treatment, although effective in a substantial portion of patients, may potentially cause many side effects. Among them, cardiovascular safety is one of the main concerns.
In the present study, we investigated the impact of treatment with anti-TNF-α and anti-IL-6 agents on heart function and levels of heart function biomarkers.
To measure this, we used cardiac function biomarkers, such as NT-pro Brain Natriuretic Peptide, mid regional pro-Atrial Natriuretic Peptide, Galectin-3, and Heart-Type Fatty Acid-Binding Protein and compared them to patients treated with methotrexate as well as healthy controls.
Patients treated with biologics were characterized by low disease activity or were in remission. The disease activity in these groups was significantly lower than in the methotrexate group. All patients recruited for the study were characterized by normal heart function measured using echocardiography (EF>50%). With the exception of MR-proANP between tocilizumab and adalimumab (median: 1.01 vs. 0.49 nmol/L, p<0.05), we failed to observe any significant differences in biomarkers levels between groups treated with biologics. Contrary to this, patients on MTX showed higher NT-proBNP levels compared to adalimumab and healthy controls (p<0.05 for both). Striking differences have been shown in regard to H-FABP. The levels of these biomarkers were elevated in all biologics and the methotrexate group compared to healthy controls.
As this biomarker reflects potential heart injury, we suggest that heart damage proceeds in a continuous manner in RA patients despite effective treatment and attainment of remission/low disease activity. This finding, however, should be verified in a larger cohort of RA patients to ascertain if the routine assessment of H-FABP may be useful for the detection of patients with RA who are at risk of development of heart damage.
类风湿关节炎（RA）是最常见的炎症性关节炎形式，影响全球约 1%的人口。针对促炎细胞因子（TNF-α 和白细胞介素-6）的新型治疗策略的引入彻底改变了 RA 的治疗方法。虽然这种治疗在很大一部分患者中有效，但可能会引起许多副作用。其中，心血管安全性是主要关注点之一。
在本研究中，我们研究了抗 TNF-α 和抗 IL-6 药物治疗对心脏功能和心脏功能生物标志物水平的影响。
为了测量这一点，我们使用了心脏功能生物标志物，如 NT-pro 脑利钠肽、中段 pro 心房利钠肽、半乳糖凝集素-3 和心脏型脂肪酸结合蛋白，并将其与接受甲氨蝶呤治疗的患者以及健康对照组进行了比较。
接受生物制剂治疗的患者疾病活动度低或处于缓解期。这些组的疾病活动度明显低于甲氨蝶呤组。所有入组研究的患者均通过超声心动图测量心脏功能正常（EF>50%）。除了托珠单抗和阿达木单抗之间的 MR-proANP（中位数：1.01 与 0.49 nmol/L，p<0.05）外，我们未能观察到生物制剂治疗组之间生物标志物水平的任何显著差异。与此相反，MTX 组的 NT-proBNP 水平高于阿达木单抗组和健康对照组（均为 p<0.05）。H-FABP 表现出显著差异。与健康对照组相比，所有生物制剂和甲氨蝶呤组的这些生物标志物水平均升高。
由于这种生物标志物反映了潜在的心脏损伤，我们认为尽管进行了有效治疗并达到了缓解/低疾病活动度，但 RA 患者的心脏损伤仍在持续进行。然而，这一发现需要在更大的 RA 患者队列中得到验证，以确定常规评估 H-FABP 是否有助于发现有发生心脏损伤风险的 RA 患者。
