Anti-tumour necrosis factor-alpha therapy over conventional therapy improves endothelial function in adults with rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is associated with cardiovascular morbidity and mortality and inflammation contributes to related endothelial dysfunction. We aimed to investigate the effect of anti-TNFalpha therapy on endothelial function in subjects with rheumatoid arthritis. We measured flow-mediated (FMD) and GTN-mediated dilation of the brachial artery before and following 36 weeks of anti-TNFalpha therapy in nine RA patients and in a group of RA patients on conventional therapy. Thirty-six weeks of anti-TNFalpha therapy improved FMD relative to those on conventional therapy (8.65 +/- 1.50 vs. 1.70 +/- 1.36%, P = 0.02). No significant changes in GTN responses were evident. Significant improvements in tender (P = 0.03) and swollen (P = 0.02) joint counts, patients' global self-assessment (P = 0.01) and DAS-28 scores (P = 0.04) were observed in the anti-TNFalpha treated group. The addition of anti-TNFalpha treatment to conventional therapy, in those with severe RA, reduces inflammatory symptoms and improves endothelial function, potentially lowering future atherosclerotic risk.

Endothelial dysfunction in rat adjuvant‐induced arthritis: Up‐regulation of the vascular arginase pathway

“…To confirm that the abnormal response of vessels from AIA rats to ACh was not due to decreased response of vascular smooth muscle cells to NO, we demonstrated that the relaxing effect of the NO donor SNP was not impaired in the AIA rats. This result is in accordance with recent study findings in AIA rats (12,14,36) as well as in RA patients (37)(38)(39)(40). Likewise, we verified that the contractile response of vessels from AIA rats to NE was not different from that of control rats.…”

The effect of anti-tumor necrosis factor (TNF)-alpha therapy with etanercept on endothelial functions in patients with rheumatoid arthritis

“…Since anti-TNF-α treatment reduces disease activity in RA patients and accepted as a useful new therapeutic option in RA (14,15), it was assumed that TNF-α blockers may also improve arterial elasticity and as a result vascular functions. With this regard, in several studies, the validity of this hypothesis was investigated with different type of TNF-α blockers such as infliximab (17)(18)(19)21) and ENC (16,20,22).…”

“…TNF-α inhibitors have recently been demonstrated to be very effective in controlling signs and symptoms in approximately two thirds of patients with RA (14,15). In recent years, the effects of different types of TNF-α inhibitors on endothelial functions were investigated in a limited number of studies and controversial results were published (16)(17)(18)(19)(20)(21)(22).…”

Angiotensin-Converting Enzyme Inhibition Improves Vascular Function in Rheumatoid Arthritis

“…This is further supported by recent findings that ACE inhibition with quinapril reduces articular TNF-␣ production 41 and by beneficial effects of anti-TNF-␣ treatment on endothelial function in RA. 9,42,43 It is of note that all patients in this study presented with moderate disease activity; they had to remain clinically stable to allow comparable conditions during the repetitive assessment of the end points at different time points throughout the study. Circulating levels of these cytokines may, however, only partially reflect local vascular changes.…”