Abstract
BackgroundPatients with inflammatory arthritis die prematurely of cardiovascular disease. Inflammation activates platelets. Since treatment of inflammatory arthritis is associated with reduced mortality, and decreased platelet reactivity reduces cardiovascular events, we hypothesised that platelet reactivity as measured by dynamic platelet function (DPF) would be increased in patients with inflammatory arthritis and that reactivity could be reduced with therapeutic intervention.ObjectivesTo characterise platelet function using a validated physiological assay in patients with inflammatory arthritis before and after disease improvement.Methods22 patients were recruited and treated as per local protocol. DPF was measured at baseline and after clinical improvement. Video microscopy was utilised to measure dynamic platelet behaviour in microliters of blood perfused over von Willebrand factor (VWF) at arterial shear rates (1500 s-1). Motion-analysis software measured the number of platelets interacting with VWF, translocating across VWF, the speed and distance platelets travelled across VWF, and stably adhering to the surface. Platelet parameters at baseline and following improvement were compared using Wilcoxon signed rank test and paired student t-test. Changes in platelet function were correlated to inflammatory disease markers by Pearson Correlation.Results18 patients completed the study. Platelet adhesion decreased and platelet motion increased following treatment. Tender joint count correlated with platelet adhesion (Pearson r = 0.616, p≤0.01) while CRP correlated with velocity of platelet movement (Pearson r = 0.563, p≤0.01).ConclusionsImprovement in clinical markers of inflammation is associated with a corresponding change in platelet function. Given the association between reduced mortality and decreased platelet reactivity our results suggest that an appropriate assay of platelet function could guide future therapy of patients with inflammatory arthritis.
Highlights
Inflammatory arthritis is an umbrella term for rheumatologic conditions in which joints are inflamed
Tender joint count correlated with platelet adhesion (Pearson r = 0.616, p 0.01) while CRP correlated with velocity of platelet movement (Pearson r = 0.563, p 0.01)
Given the association between reduced mortality and decreased platelet reactivity our results suggest that an appropriate assay of platelet function could guide future therapy of patients with inflammatory arthritis
Summary
Inflammatory arthritis is an umbrella term for rheumatologic conditions in which joints are inflamed. It has been recognised that patients with inflammatory arthritis have increased cardiovascular risk and higher mortality rates compared to the general population [1] Patients with these inflammatory conditions are exposed to greater levels of inflammatory cytokines which accelerate end organ damage and promote atherosclerosis. Rheumatoid arthritis patients have a prevalence of cardiovascular disease 50% higher than the general population and this represents their leading cause of mortality [2, 3]. This association with increased cardiovascular disease could be considered an extraarticular manifestation of inflammatory arthritis [4]. Since treatment of inflammatory arthritis is associated with reduced mortality, and decreased platelet reactivity reduces cardiovascular events, we hypothesised that platelet reactivity as measured by dynamic platelet function (DPF) would be increased in patients with inflammatory arthritis and that reactivity could be reduced with therapeutic intervention
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