Clinical Improvement in Rheumatoid Arthritis Is Associated with Healthier Microvascular Function in Patients Who Respond to Antirheumatic Therapy
Clinical Improvement in Rheumatoid Arthritis Is Associated with Healthier Microvascular Function in Patients Who Respond to Antirheumatic Therapy
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DOI：
10.3899/jrheum.090417
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发表时间：
2010-03-01
影响因子：
3.9
通讯作者：
Khan, Faisel
中科院分区：
文献类型：
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作者：
Galarraga, Bernat;Belch, Jill J. F.;Khan, Faisel
Objective.风湿性关节炎（RA）与心血管（CV）死亡率增加相关。微血管内皮功能障碍发生在CV疾病发展的早期，并因炎症而恶化。药物治疗RA对微血管功能的影响研究甚少。我们评估了抗风湿治疗对RA患者微血管内皮功能的影响，特别是对治疗有反应者与无反应者的比较。在基线时以及抗肿瘤坏死因子-α药物（依那西普，n = 27，阿达木单抗，n = 3）或甲氨蝶呤（n = 21）治疗2个月和4个月后，对51例活动性RA且无CV疾病既往史的患者进行了评估。在每次研究访视时评估RA疾病活动度、炎症指标和皮肤微血管反应，这些指标在离子电渗递送乙酰胆碱（ACh）和硝普钠（SNP）后使用激光多普勒成像进行测量。疾病活动性评分（DAS 28）从基线至访视2和3显著降低（分别为6.04 +/- 1.2、4.34 +/- 1.3、4 +/- 1.3; p < 0.0001）。整个队列的内皮依赖性（ACh）和非依赖性（SNP）反应在药物治疗后没有显著改善（分别为p = 0.250，p = 0.062）。对抗风湿治疗有反应的患者（n = 31）进行分析时，ACh（p = 0.028）和SNP反应（p = 0.019）均有显著改善。抗风湿治疗后微血管内皮功能改善。这些结果支持RA患者在CV效应方面的有效治疗的重要性，这可能会外推到未来CV事件的减少。临床试验注册号ISRCTN 57761809。（2010年1月15日首次发布; J Rheumol 2010;37：521-8; doi：10.3899/jrheum.090417）
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 anti rheumatic 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-alpha 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. (First Release Jan 15 2010; J Rheumatol 2010;37:521-8; doi:10.3899/jrheum.090417)