RT Journal Article
SR Electronic
T1 Clinical Improvement in Rheumatoid Arthritis Is Associated with Healthier Microvascular Function in Patients Who Respond to Antirheumatic Therapy
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.090417
DO 10.3899/jrheum.090417
A1 Bernat Galarraga
A1 Jill J.F. Belch
A1 Tom Pullar
A1 Simon Ogston
A1 Faisel Khan
YR 2010
UL http://www.jrheum.org/content/early/2010/01/11/jrheum.090417.abstract
AB 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-α 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.