RESEARCH - Inflammation and microvascular and macrovascular endothelial dysfunction in RA: effect of treatment

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J Rheumatol. 2010 Feb 15.

Inflammation and Microvascular and Macrovascular Endothelial

Dysfunction in Rheumatoid Arthritis: Effect of Treatment.

W, Carruthers D, Lip GY, Blann AD.

From the University of Birmingham Centre for Cardiovascular Sciences,

Department of Medicine, and the Department of Rheumatology, City

Hospital, Birmingham, England.

OBJECTIVE: To determine whether abnormalities in microvascular and

macrovascular function in rheumatoid arthritis (RA) are associated

with plasma markers [von Willebrand factor (VWF)] of endothelial

dysfunction and inflammation [C-reactive protein (CRP)] and whether

the abnormalities would be altered by treatment. Endothelial

dysfunction and inflammation in RA may contribute to adverse

cardiovascular events. Although endothelial dysfunction in RA has been

demonstrated by altered plasma markers, the relationships with

macrovascular and microvascular function are relatively unexplored.

METHODS: We recruited 66 patients with chronic RA, 48 community

controls (CC), and 25 patients with diabetes and hypertension as a

disease control group (DC). Subjects had venous blood sampled for

plasma markers, and underwent laser Doppler perfusion imaging of

forearm skin (to assess microvascular circulation) following

acetylcholine and sodium nitroprusside iontophoresis, to assess

endothelium-dependent and endothelium-independent responses,

respectively. Brachial artery flow-mediated dilatation assessed

endothelial dysfunction in a macrovascular bed. A subgroup of 29

patients with RA were assessed pretherapy and after 2-4 weeks of

antirheumatic therapy.

RESULTS: As expected, patients with RA had higher CRP, erythrocyte

sedimentation rate (ESR), and VWF. Endothelium-independent

vasoreactivity was abnormal in RA, and this correlated negatively with

CRP. All aspects of microvascular function were abnormal in the DC

compared to the CC. Macrovascular function was preserved in RAbut was

abnormal in the DC group. Four weeks of anti-inflammatory therapy

reduced CRP and ESR but had no effect on any vascular function index

in the patients with RA.

CONCLUSION: Patients with RA have abnormal endothelium-independent

microvascular function that correlates with inflammation but is not

altered by short-term antiinflammatory therapy.

PMID: 20156948

http://www.ncbi.nlm.nih.gov/pubmed/20156948

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