Inflammatory suppression rapidly attenuates microvascular dysfunction in rheumatoid arthritis
Inflammatory suppression rapidly attenuates microvascular dysfunction in rheumatoid arthritis
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DOI：
10.1016/j.atherosclerosis.2006.05.034
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发表时间：
2007-06-01
期刊：
影响因子：
5.3
通讯作者：
Sattar, Naveed
中科院分区：
文献类型：
--
作者：
Datta, Deepankar;Ferrell, William R.;Sattar, Naveed
类风湿性关节炎(RA)与心血管疾病的发病率和死亡率相关，RA的炎症成分与这种额外风险密切相关。内皮功能障碍与动脉粥样硬化有关，已在RA较大的血管中得到证实。在这项先导性研究中，我们首次确定了活动期RA患者的皮肤微血管功能是否受损，并确定了其对抗炎治疗的反应。使用激光多普勒成像结合血管扩张剂乙酰胆碱(ACh，内皮依赖)和硝普钠(SNP，非内皮依赖)到前臂的离子导入来评估这一点。对8名因急性发作入院的RA患者在抗炎治疗前后进行评估。获得标准的实验室指标和痛觉(VAS)。包括8名受试者的对照组用于基线比较。与这组患者相比，RA患者的血管功能显著降低(P<；0.00001)。治疗后，随着C反应蛋白和血管紧张素转换酶的降低，ACh(P<；0.00001)和SNP(P=0.001)的血管功能均有改善，ACh的这种改善明显(P<；0.001)。RA患者的血管功能障碍明显，甚至在皮肤微循环水平，但随着炎症的消退而改善。皮肤血管功能的评估可能是RA血管风险的有用的、非侵入性的替代指标，包括心肌微血管异常。(C)2006爱思唯尔爱尔兰有限公司。保留所有权利。
Rheumatoid arthritis (RA) is associated with greater risk of cardiovascular morbidity and mortality, the inflammatory component of RA being strongly linked to this excess risk. Endothelial dysfunction is linked to atherosclerosis and has been demonstrated in larger vessels in RA. In this pilot study, we determined for the first time whether skin microvascular function was impaired in patients with active RA and also determined its response to anti-inflammatory treatment. This was assessed non-invasively using laser Doppler imaging combined with iontophoresis of the vasodilators acetylcholine (ACh, endothelium dependent) and sodium nitroprusside (SNP, endothelium independent) to the forearm. Eight RA patients admitted for acute flare-ups were assessed before and following anti-inflammatory treatment. Standard laboratory indices were obtained along with pain perception (VAS). A control group of eight subjects was included for baseline comparison. Compared to this group, vascular function was substantially and significantly (P < 0.00001) lower in RA patients. Following treatment, as CRP and VAS decreased, vascular function improved for both ACh (P < 0.00001) and SNP (P = 0.001), this improvement being significantly greater for ACh (P < 0.001).Vascular dysfunction is evident in RA patients, even at the level of the cutaneous microcirculation, but improves as inflammation regresses. Assessment of cutaneous vascular function may be a useful, non-invasive surrogate indicator of vascular risk in RA, inclusive of myocardial microvascular abnormalities. (c) 2006 Elsevier Ireland Ltd. All rights reserved.