RESEARCH - Effects of anti-TNF-alpha treatment on lipid profile in patients with active RA

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Ann N Y Acad Sci. 2006 Jun;1069:414-9.

Effects of anti-TNF-alpha treatment on lipid profile in patients with

active rheumatoid arthritis.

Seriolo B, Paolino S, Sulli A, Fasciolo D, Cutolo M.

Division of Rheumatology, Department of Internal Medicine and Medical

Specialities, University of Genova, Genova, Italy.

Cardiovascular morbidity and mortality appear to be increased in

rheumatoid arthritis (RA), which might be due to increased prevalence

of risk factors for cardiovascular disease, such as an accelerated

progression of atherosclerosis. Patients with active RA frequently

show an atherogenic lipid profile, which has been linked with the

inflammatory reaction. Tumor necrosis factor-alpha (TNF-alpha), a

pivotal proinflammatory cytokine implicated in the pathogenesis of

atherosclerosis in RA, may be involved in the development of the

altered lipid profile observed in active RA. Our aim was to

investigate the effects of anti-TNF-alpha treatment in combination

with methotrexate (MTX) and corticosteroid therapy on lipid profile in

patients with active RA.

In this prospective study 34 consecutive RA patients were included

(all women, mean age 51.6 +/- 7.9 years, range 46-72 years) with

active (defined as Disease Activity Index 28 joint score [DAS-28], of

at least 3.2) and refractory RA, in stable treatment with MTX (7.5-10

mg/week) and prednisone (7.5-10 mg/day) for 3 months. All patients

received TNF-alpha blockers (n = 16, etanercept 25 mg twice weekly; n

= 14, infliximab 3 mg/kg on 0, 2, 6, and every 8 weeks thereafter; and

finally, n = 4, adalimumab 40 mg every other week). Total cholesterol,

high-density lipoprotein cholesterol (HDL cholesterol), triglycerides

(TG) and lipoprotein (a) [Lp(a)] levels and the atherogenic index

(ratio cholesterol/HDL cholesterol) were measured at base line, and at

16 and 24 weeks.

Results were as follows: The DAS-28 was 6.9 +/- 2.1 at base line and

decreased to 4.6 +/- 1.8 after 16 weeks, and further to 4.1 +/- 1.3

after 24 weeks (both, P < 0.01). Following anti-TNF-alpha treatment,

the mean levels of total cholesterol were 168 +/- 24 mg/dL at base

line and increased to 188 +/- 28 mg/dL at 16 weeks (P < 0.01), and 197

+/- 26 mg/dL at 24 weeks (P < 0.001). However, also the mean levels of

HDL cholesterol were significantly higher than basal values after 16

and 24 weeks of treatment (34 +/- 12 mg/dL versus 36 +/- 18 mg/dL [P <

0.05] and 38 +/- 14 mg/dL [P < 0.01], respectively). TG and Lp(a)

levels, as well as the atherogenic index were not significantly

changed. Interestingly, variations in disease activity were

significantly and inversely correlated with HDL cholesterol levels.

In conclusion: Short anti-TNF-alpha treatment was associated with a

significant increase of both total cholesterol and HDL cholesterol

levels, and correlated with decreased disease activity. The

atherogenic index showed no changes during the study. Therefore,

anti-TNF-alpha treatment might affect lipid profile in RA patients.

PMID: 16855168

http://www.ncbi.nlm.nih.gov/pubmed/16855168

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