Conversion towards an atherogenic lipid profile in rheumatoid arthritis patients during long‐term infliximab therapy

Abstract

Objectives: To analyse the effects of infliximab infusions on serum levels of lipids in patients with rheumatoid arthritis (RA) treated for 2 years.Methods: Fifty‐two patients (41 females and 11 males) with RA undergoing infliximab treatment (3 mg/kg) were consecutively recruited into the study. The mean (±SD) age of the patients was 54.6±12.5 years and mean disease duration was 14.1±8.6 years. Blood was sampled before infusion at baseline, and at 3, 6, 12, 18 and 24 months. Forty‐one of the patients were also treated with methotrexate, 13 with other disease‐modifying anti‐rheumatic drugs (DMARDs) and 28 with prednisolone (<10 mg daily). For comparison, lipid levels were followed for 2 years in 70 consecutively included patients with early RA during treatment with conventional DMARDs.Results: There was an initial increase in plasma levels of cholesterol, high density lipoprotein (HDL)‐cholesterol, low density lipoprotein (LDL)‐cholesterol, and LDL/HDL and total/HDL cholesterol ratios. However, after 3 months HDL‐cholesterol decreased significantly, followed after 6 months by cholesterol and LDL‐cholesterol. The LDL/HDL and total/HDL‐cholesterol ratios remained significantly raised. HDL‐cholesterol increased and the ratios improved in patients with early RA receiving conventional treatment. The changes over time differed significantly between the patient groups.Conclusion: During infliximab infusion a pro‐atherogenic lipid profile developed despite reduced inflammatory activity. The long‐term decrease in HDL‐cholesterol was unexpected considering the known effects of tumour necrosis factor‐alpha (TNFα).