Rheumatology Advance Access originally published online on September 4, 2009
Rheumatology 2009 48(11):1418-1423; doi:10.1093/rheumatology/kep251
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Etanercept improves inflammation-associated arterial stiffness in rheumatoid arthritis
1The Institute of Cardiovascular Research, Vascular and Inflammatory Diseases Research Unit, Ninewells Hospital and Medical School, Dundee, UK.
Correspondence to: Bernat Galarraga, The Institute of Cardiovascular Research, Vascular and Inflammatory Diseases Research Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. E-mail: lauberdoc{at}hotmail.com
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Abstract |
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Objectives. Increased arterial stiffness, an independent risk factor for premature coronary artery disease, has been reported in patients with RA. The objectives of this study were first to assess, in patients with RA, the relationship between disease activity, inflammation and augmentation index, which is a combined measure of arterial stiffness and pulse wave reflection. The second objective was to establish any effect anti-rheumatic treatment may have on augmentation index.
Methods. One hundred and forty-eight RA patients with no previous history of cardiovascular disease (CVD) had their augmentation index corrected for a heart rate of 75 beats per minute (AIx@75), and parameters of RA disease activity and CV risk measured. Forty-seven patients were then treated with either MTX (n = 21) or etanercept (ETAN) (n = 26), and assessments were repeated at 2 and 4 months.
Results. Patients with high CRP (>10 mg/l) showed significantly higher mean AIx@75 than those with low CRP (
10 mg/l) (33 ± 8 vs 30 ± 8%; P = 0.033). On regression analysis, log10 CRP (β = 0.298; P = 0.002), gender (β = 0.257; P = 0.007), BMI (β = –0.292; P = 0.004), diastolic blood pressure (β = 0.260; P = 0.009) and age (β = 0.194; P = 0.046) were independently associated with AIx@75. Treatment with ETAN (35 ± 9, 32.5 ± 1 and 32.5 ± 8%; P = 0.025) but not MTX (31 ± 1, 31 ± 1 and 31 ± 1%; P = 0.971) attenuated the AIx@75 significantly from baseline to Visits 2 and 3.
Conclusions. Systemic inflammation (CRP) is an independent predictor of arterial stiffness and pulse wave reflection in patients with RA. ETAN but not MTX therapy reduces arterial stiffness and pulse wave reflection and may thus improve CV morbidity in RA.
KEY WORDS: Atherosclerosis, Inflammation, Arterial stiffness, Rheumatoid arthritis, Etanercept
Submitted 12 February 2009;
revised version accepted 17 July 2009.
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