Rheumatology Advance Access published online on April 20, 2007
Rheumatology, doi:10.1093/rheumatology/kem089
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Response to anti-tumour necrosis factor alpha blockade is associated with reduction of carotid intima-media thickness in patients with active rheumatoid arthritis
La Sapienza Università di Roma, II Facoltà di Medicina e Chirurgia, Azienda Ospedaliera S.Andrea, Dipartimento di Scienze Mediche; I Facoltà di Medicina e Chirurgia 1Dipartimento di Medicina Clinica2Dipartimento di Medicina Sperimentale
Correspondence to:
Flavia Del Porto, Università ‘La Sapienza’, II Facoltà di Medicina e Chirurgia, Azienda Ospedaliera Sant’Andrea, Dipartimento di Scienze Mediche, Via di Grottarossa 1039 00189 Rome, Italy. E-mail: flavia.delporto{at}uniroma1.it
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Abstract |
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Objectives. To determine whether tumour necrosis factor (TNF)-
blockers may reduce carotid intima-media thickness (cIMT) in patients with active rheumatoid arthritis (RA) steadily responsive to such therapy.
Methods. From 287 consecutive RA patients attending our out-patient clinic and diagnosed on the basis of the American College of Rheumatology (ACR) criteria, 49 without traditional cardiovascular risk factors and meeting the requirements for TNF- blockers therapy were selected. Among them, 39 actually started TNF- blockers, but only 30, who reached at least a response on the ACR 20% improvement criteria at 14 weeks, maintained during the whole year of treatment, were finally considered (group A). The remaining 10/49, homogeneous for age, sex, traditional cardiovascular risk factors, socioeconomic status, disease activity and duration, who did not consent to TNF--blocker administration, were used as controls (group B). Disease activity score in 44 joints (DAS44), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were evaluated before starting the study, and 3, 6, 12 months thereafter; cIMT was measured by ultrasound before and 12 months thereafter only.
Results. Patients in group A showed a very significant cIMT reduction (P < 0.0001 and P < 0.0001, on the right and left side, respectively), preceded by an early and lasting significant decrease in DAS44, ESR and CRP. Moreover, a significant correlation was found between cIMT and DAS44 (r = 0.435, P < 0.05).
Conclusions. These results demonstrate that TNF- blockade is associated with cIMT reduction in RA patients steadily responsive to therapy, probably by lowering inflammation.
KEY WORDS: Rheumatoid arthritis, Cytokines, Cardiovascular diseases, Atherosclerosis, Drug therapy, TNF- blockers
*These two authors contributed equally to the study
Submitted 4 January 2007;
revised version accepted 19 March 2007.
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