RESEARCH - Remicade improves vascular stiffness in patients with RA

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Ann Rheum Dis. Published Online First: 17 October 2008.

doi:10.1136/ard.2007.086157

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Extended Report

Infliximab improves vascular stiffness in patients with rheumatoid arthritis

Melinda Wong 1, Philip Oakley 1, Laurel Young 1, BenYu Jiang

2, S Wierzbicki 2, Panayi 3, Phil Chowienczyk 2 and

Bruce W Kirkham 1*

1 Guy's and St. ' NHS Foundation Trust, London, United Kingdom

2 St. ' Hospital and King's College, London, United Kingdom

3 King's College, London, United Kingdom

Abstract

Objectives: Patients with rheumatoid arthritis (RA) have increased

cardiovascular mortality. Tumour necrosis factor (TNF)-blocking

therapy has been shown to reduce RA disease activity measures and

joint damage progression. Some observational studies suggest TNF

blockade reduces mortality and incidence of first cardiovascular

events. The mechanisms contributing to these outcomes are unclear.

This study assessed the effects of infliximab treatment on vascular

stiffness and structure in patients with RA.

Methods: This post-hoc analysis of longitudinal data from a randomised

placebo-controlled study evaluated the effect of infliximab upon

vascular assessments. 26 patients received intravenous infliximab

(3mg/kg) at weeks 0, 2, 6 and every 8 weeks thereafter to week 54.

Patients were followed up to 56-weeks of infliximab therapy with

assessments of RA disease activity, cardiovascular risk factors,

vascular stiffness (pulse wave velocity [PWV]), carotid intima-media

thickness (CIMT) and carotid artery plaque (CAP). Univariate analyses

of changes over time by repeated measures analysis of variance (RM

ANOVA) were followed by multivariate time-series regression analysis

(TSRA) if changes were seen.

Results: PWV was significantly lower (better) after 56 weeks of

treatment with infliximab (ANOVA p<0.01, TSRA p<0.01). However CIMT

(ANOVA p=0.50) and CAP (2=4.13, p=0.88) did not change over the study

period. Multiple cardiovascular risk measures did not change with

therapy and did not correlate with changes in measures of vascular

structure.

Conclusions: Arterial stiffness improves with infliximab treatment in

RA. This change may help explain the improved cardiovascular disease

survival in RA patients receiving TNF-blocking therapy.

http://ard.bmj.com/cgi/content/abstract/ard.2007.086157v1?papetoc

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