P057 Effects of ANTI-TNF therapy on vascular biomarker levels in rheumatoid arthritis
Authors: A Hamar, E Végh, Á Horváth, S Szántó, G Szucs, A Pusztai, A Domján, K Hodosi, G Kerekes, R Gesztelyi, J Zsuga, Z Prohászka, Z Szekanecz
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Introduction</h3> Prevoius studies have shown an increased risk of cardiovascular disease in rheumatoid arthritis (RA), due to RA-associated inflammation. Different vascular biomarkers, such as anti-hsp65 antibodies, asymmetric dimethylarginine (ADMA) and B-type natriuretic peptide (BNP) have been associated with atherosclerosis and RA. Anti-hsp65 antibodies were found in RA patients and these antibodies linked also to inflammation and atherosclerosis. ADMA is an endogenous competitive inhibitor of NOS and consequential can lead to increased nitrosative and oxidative stress. ADMA has been implicated with atherosclerosis, and also with rheumatoid arthritis. BNP also associated to cardiovascular diseases. <h3>Objectives</h3> The aim of this study was to assess the effects of anti-TNF therapy on different vascular biomarkers, such as anti-hsp65, ADMA and BNP in patients with RA and their correlation with different laboratory and clinical markers. <h3>Methods</h3> Altogether 36 RA patients were recruited and treated with either etanercept (ETN) or certolizumab pegol (CZP) in this 12 months follow-up study. Assessments were performed at baseline, at month 6 and 12. Amounts of IgG antibodies reacting with recombinant M. bovis hsp65 (Lionex, Braunschweig, Germany) were measured by ELISA. ADMA was assesed by HPLC with fluorescent detection. BNP fragments were assessed by commercially avaiable ELISA kit (Biomedica, Vienna). In addition, disease activity (DAS28), age, disease duration, CRP, IgM rheumatoid factor (RF), anti-CCP (aCCP) and plasma lipid levels were also measured. Arterial flow-mediated vasodilation (FMD), carotid intima-media thickness (cIMT) and arterial pulse-wave velocity (PWV) were assessed by ultrasound. <h3>Results</h3> There were no significant changes in the levels of anti-hsp60, ADMA and BNP due to anti-TNF therapy. However, baseline level of BNP is correlated with the levels of RF (R=0.479, p=0.004) and aCCP (R=0.591, p&lt;0.001). Serum BNP levels at baseline and at month 6 were significantly increased in RF positive compared to RF negative patients (680.60±381.64 versus 292.94±198.27 pmol/L; p=0.007 and 668.95±346.51 versus 312.20±207.01 pmol/L; p=0.001) and also in aCCP postive compared to aCCP negative patients (670.61±323.04 versus 137.98±436.41 pmol/L; p=0.030 and 652.93±283.21 versus 456.48±423.11 pmol/L; p=0.021). Furthermore we found the following correlations between baseline values: anti-hsp60 level correlated with ADMA (R=0.900, p=0.037), triglyceride (TG) (R=0.462,p=0.040) and PWV (R=0.564, p=0.040). Baseline level of ADMA positively correlated with body mass index (BMI) score (R=0.720, p=0.040) and also with HDL levels (high density lipoprotein) of patients (R=0.473, p=0.047). <h3>Conclusions</h3> BNP levels were significantly higher in RF +compared to RF- patients, which imply that BNP may associate with RF positivity. Specific biomarkers, such as ADMA, anti-hsp60 and BNP may play important role cardiovascular disease in RA. <h3>Acknowledgements</h3> The work is supported by the GINOP-2.3.2-15-2016-00015/I-KOM TEAMING project. <h3>Disclosure of interest</h3> None declared