RESEARCH - Improvement RA is associated with healthier microvascular function in patients who respond to antirheumatic therapy

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J Rheumatol. 2010 Jan 15.

Clinical Improvement in Rheumatoid Arthritis Is Associated with

Healthier Microvascular Function in Patients Who Respond to

Antirheumatic Therapy.

Galarraga B, Belch JJ, Pullar T, Ogston S, Khan F.

From the Vascular and Inflammatory Diseases Research Unit, Centre for

Cardiovascular and Lung Biology, Division of Medical Sciences,

Ninewells Hospital and Medical School, Dundee; and the Public Health

Section, Community Health Science Division, University of Dundee,

Dundee, UK.

OBJECTIVE: Rheumatoid arthritis (RA) is associated with increased

cardiovascular (CV) mortality. Microvascular endothelial dysfunction

occurs early in the development of CV disease and is worsened by

inflammation. The effect of drug treatment for RA on microvascular

function has been poorly studied. We assessed the effect of

antirheumatic treatment on microvascular endothelial function in

patients with RA, particularly to examine responders versus

nonresponders to therapy.

METHODS: Fifty-one patients with active RA and no previous history of

CV disease were assessed at baseline and after 2 and 4 months' therapy

with either anti-tumor necrosis factor-alpha drugs (etanercept, n =

27, adalimumab, n = 3) or methotrexate, n = 21. RA disease activity,

inflammatory measures, and skin microvascular responses, measured

using laser Doppler imaging after iontophoretic delivery of

acetylcholine (ACh) and sodium nitroprusside (SNP), were assessed at

each study visit.

RESULTS: Disease Activity Score (DAS28) decreased significantly from

baseline to visit 2 and 3 (6.04 +/- 1.2, 4.34 +/- 1.3, 4 +/- 1.3,

respectively; p < 0.0001). Endothelium-dependent (ACh) and independent

(SNP) responses for the whole cohort did not improve significantly

after drug treatment (p = 0.250, p = 0.062, respectively). When

patients who responded to antirheumatic therapy (n = 31) were

analyzed, there were significant improvements in both ACh (p = 0.028)

and SNP responses (p = 0.019).

CONCLUSION: Microvascular endothelial function improves in patients

who respond to antirheumatic therapy. These results support the

importance of effective therapy for RA patients in terms of CV

effects, which might extrapolate to reduced CV events in the future.

Clinical trial registration no. ISRCTN57761809.

PMID: 20080919

http://www.ncbi.nlm.nih.gov/pubmed/20080919

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