Abstract
BackgroundAortic stiffness index (AoSI) has to be considered a proxy outcome measure in patients with rheumatoid arthritis (RA). The aim of this study was to comparatively describe AoSI progression in two groups of RA patients on long-term treatment with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) with or without tumour necrosis factor inhibitors (TNFi).MethodsAoSI was evaluated by Doppler echocardiography at the level of the aortic root, using a two-dimensional guided M-mode evaluation. Eligible participants were assessed at baseline and after 12 months. Changes in serum lipids, glucose and arterial blood pressure were assessed. All patients who did not change DMARD treatment during follow-up were consecutively selected for this study.ResultsWe included 107 (64 TNFi and 43 csDMARDs) RA patients. Most patients (74%) were in remission or low disease activity and had some CVD risk factors (45.8% hypertension, 59.8% dyslipidaemia, 45.3% smoking). The two groups did not differ significantly for baseline AoSI (5.95±3.73% vs 6.08±4.20%, p=0.867). Follow-up AoSI was significantly increased from baseline in the csDMARDs group (+1.00%; p<0.0001) but not in the TNFi group (+0.15%, p=0.477). Patients on TNFi had significantly lower follow-up AoSI from baseline than the csDMARDs group (−1.02%, p<0.001; ANCOVA corrected for baseline AoSI, age and systolic blood pressure). Furthermore, follow-up AoSI was significantly lower in TNFi than in csDMARDs users with an increasing number of CVD risk factors.ConclusionLong-term treatment with TNFi was associated with reduced aortic stiffness progression in patients with established RA and several CVD risk factors.
Highlights
Rheumatoid arthritis (RA) is a chronic immune-mediated and inflammatory disease characterized by a 48% increased risk of cardiovascular (CV) events and a 50% higher incidence of cardiovascular disease (CVD)-related mortality compared with the general population [1, 2]
Patients in the csDMARDs and tumour necrosis factor inhibitors (TNFi) groups were balanced for the proportion of CVD risk factors and medications, and there were no significant differences in baseline systolic blood pressure (SBP), diastolic blood pressure (DBP) or serum lipids
Our results seem to indicate that TNFi treatment could be associated with reduced arterial stiffness in patients with established, long-standing rheumatoid arthritis (RA) with several CVD risk factors
Summary
Rheumatoid arthritis (RA) is a chronic immune-mediated and inflammatory disease characterized by a 48% increased risk of cardiovascular (CV) events and a 50% higher incidence of cardiovascular disease (CVD)-related mortality compared with the general population [1, 2].There is growing evidence that increased arterial stiffness may account for the excess risk of CVD in RA [3,4,5,6,7,8]. Rheumatoid arthritis (RA) is a chronic immune-mediated and inflammatory disease characterized by a 48% increased risk of cardiovascular (CV) events and a 50% higher incidence of cardiovascular disease (CVD)-related mortality compared with the general population [1, 2]. When structural and functional changes of the elastic fibres within the arterial wall occur, arteries progressively lose their low-stretch bearing component, longitudinal elasticity and geometry, leading to collagen deposition with decreased elasticity and stiffness, elongation and increased tortuosity [12]. The aim of this study was to comparatively describe AoSI progression in two groups of RA patients on long-term treatment with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) with or without tumour necrosis factor inhibitors (TNFi)
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