Abstract
Rheumatoid arthritis (RA) has been associated with endothelial dysfunction, a pathophysiological feature of atherosclerosis. Our aim was to determine whether TNF-α blockade has a beneficial effect on endothelial function in RA. We performed a systematic review with meta-analysis to evaluate the effect of anti-TNF-α agents on endothelial function in RA patients. MedLine, Cochrane CENTRAL and SCOPUS were searched up to March 2016. Inclusion criteria were: 1) randomised controlled trial (RCT), quasi-RCT, before-after cohort study; 2) including RA patients; 3) treatment with anti-TNF-α medications; 4) evaluating the change from baseline in endothelial function. The search strategy retrieved 180 records, of which 20 studies were included in the systematic review. Pooled analysis using a random-effects model demonstrated a significant improvement in endothelial function following anti-TNF-α treatment (SDM 0.987, 95%CI [0.64–1.33], p < 0.0001). Generalisation of the results of the meta-analysis may be limited due to the presence of heterogeneity (I2 = 82.65%, p < 0.001) and evidence of possible publication bias. Meta-regression showed that endothelial function measurement technique was a significant contributor to heterogeneity. In conclusion, although limited by the methodological quality of the included studies, our meta-analysis suggests that anti-TNF-α treatment may improve endothelial function in RA patients.
Highlights
Rheumatoid arthritis (RA) is characterised by an excess of cardiovascular diseases (CVD) risk, comparable in magnitude to that conferred by type 2 diabetes mellitus (T2DM)[1]
Amongst the remaining 34 studies selected for full-text examination, only 20 articles were reviewed in detail and included inthe systematic review
Rheumatoid arthritis has been largely associated with endothelial dysfunction, which, in turn, is emerging as a factor possibly contributing to the overall risk of CVD events in RA patients[8, 9]
Summary
Rheumatoid arthritis (RA) is characterised by an excess of cardiovascular diseases (CVD) risk, comparable in magnitude to that conferred by type 2 diabetes mellitus (T2DM)[1]. To explain this phenomenon, a synergy between traditional risk factors and inflammatory disease activity has been proposed[2]. Several techniques have been developed for the invasive and non-invasive assessment of endothelial function in humans. Most of these techniques evaluate endothelial function by quantifying the vascular response to www.nature.com/scientificreports/. Flow-mediated dilatation (FMD), venous occlusion plethysmography (VOP), peripheral arterial tonometry (PAT) and laser-Doppler iontophoresis (LDI) have been largely validated in clinical studies, each technique has advantages and disadvantages[14]
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