AB0411 TNF ALPHA INHIBITORS INFLUENCE THE CARDIOVASCULAR RISK IN RHEUMATOID ARTHRITIS PATIENTS
Authors: Jerzy Swierkot, Marta Madej, Grzegorz Rozumek
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Rheumatoid arthritis (RA) patients die because of cardiovascular diseases more often than the general population. Nowadays RA is considered as an independent risk factor for cardiovascular disease (CVD). A long-lasting inflammatory process, immunological dysregulation and endothelial dysfunction play an important role in the pathogenesis of progressive atherosclerosis in RA [1,2]. <h3>Objectives:</h3> The aim of the study was to assess the influence of biological treatment on cardiovascular risk factors in RA population <h3>Methods:</h3> 38 RA patients with active disease (DAS28&gt;5.1) and 22 age and sex matched healthy controls were enrolled in the study. All the patients were treated with TNF alpha inhibitors (n=20 etanercept, n=18 adalimumab), with the background methotrexate (10-25mg weekly). The clinical state was assessed at the beginning of the study and 6, 12 and 18 months after. All the patients underwent the following tests: DAS 28 assessment, basic laboratory measurements (including homocysteine levels, fibrinogen, lipid profile), electrocardiogram (ECG), flow-mediated dilation (FMD) and cartoid intima-media thickness (cIMT) assessment and echocardiography. The local bioethics committee approved the study (KB-753). <h3>Results:</h3> 27 woman and 11 man (71% and 29% respectively) with high disease activity despite long-term treatment with synthetic disease modifying antirheumatic drugs were enrolled in the study. Mean age was 52 years (SD ± 9,6), 95% of the patients were RF-positive, 63% anti-CCP-positive. Of them 24% were current smokers, 58% had arterial hypertension and 66% had concomitant hypercholestrolaemia. In comparison to the control group, there were statistically significantly higher values of cIMT in RA patients. Moreover there was a positive correlation between cIMT thicknes and duration of RA. A reduction of cIMT (mainly during first 12 months) and an increase in FMD values were observed in the course of the treatment (p&lt;0.05). The increase in FMD value (0.03 vs 0.37) correlated with decrease of the inflammatory markers, which may be a result of an improvement in endothelial dysfunction due to anti-TNF-alpha treatment. The decrease in total cholesterol (p&lt;0.05), LDL cholesterol (p=0.03) and Castelli risk index (p&lt;0.05) were also noted, no changes of the doses of cholesterol-lowering theraphy were done during the follow up. There was a positive correlation between homocysteine and uric acid levels and there was a statistically significant decrease in both parameters in the course of the treatment (11.31 vs 8.91 [mol/l] and 5.92 vs 4.77 [mg/dl], respectively). Normal left ventricular geometry was observed after 12 months of biological therapy in patients with concentric remodeling of the left ventricle. Furthermore echocardiography revealed a significant decrease in LVEDD, IVSD, LA, FS, RVEDD after 18 months of the biologic treatment. <h3>Conclusion:</h3> Our results confirm earlier data that TNF alpha inhibitors may favorably influence on endothelial dysfunction. Besides TNF inhibitors can protect against increase in relative wall thickness of left ventricle. The anti-TNF alpha therapy not only reduces the activity of the disease in affected joints but also has a positive impact on selected cardiovascular risk factors in RA population. <h3>References</h3> [1] Solomon DH., Goodson NJ., Katz JN., i wsp. Patterns of cardiovasular risk in rheumatoid arthritis. Ann Rheum Dis. 2006; 65: 1608-1612 [2] Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD. Metabolic syndrome in rheumatoid arthritis. Maedica (Buchar). 2012 Jun;7(2):148-52. <h3>Disclosure of Interests:</h3> None declared