Endothelial dysfunction in young patients with long-term rheumatoid arthritis and low disease activity

• Published in: Atherosclerosis 2003-09, Vol.170 (1), p.177-180
• Main Authors: Hänsel, Sven, Lässig, Grit, Pistrosch, Frank, Passauer, Jens
• Format: Article
• Language: English
• Subjects: Acetylcholine - administration & dosage; Adult; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - physiopathology; Atherosclerosis; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Blood Pressure - physiology; Cardiology. Vascular system; Endothelium, Vascular - physiopathology; Etanercept; Female; Forearm; Forearm - blood supply; Heart Rate - physiology; Homocysteine - blood; Homocysteine - drug effects; Humans; Immunoglobulin G - therapeutic use; Inflammation; Medical sciences; Methotrexate - therapeutic use; Nitroglycerin - administration & dosage; Plethysmography; Receptors, Tumor Necrosis Factor - therapeutic use; Regional Blood Flow - drug effects; Rheumatoid arthritis; Severity of Illness Index; Time; Treatment Outcome; Vasodilation - drug effects; Vasodilator Agents - administration & dosage; Women's Health
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/S0021-9150(03)00281-8

Objective: Cardiovascular mortality is excessive in patients with rheumatoid arthritis (RA). It has been proposed that the chronic inflammatory state of RA contributes to accelerated atherosclerosis. The aim of this study was to determine whether endothelial dysfunction, an early sign of arteriosclerosis, is present in young, long-term RA patients receiving standard methotrexate (MTX) therapy. Furthermore, we tested whether etanercept (ENC), a TNF-α receptor blocker, resulted in improved endothelial function compared to MTX in the same patients. Methods: We studied eight RA patients twice: (1) on MTX and (2) after MTX washout and receiving ENC. Eight healthy volunteers matching for age, gender, height, weight and conventional cardiovascular risk factors served as control (C). All participants received intrabrachial infusions of increasing doses of acetylcholine (ACh, endothelium-dependent vasodilator) and glyceryl-trinitrate (GTN, endothelium-independent vasodilator). Forearm blood flow (FBF) was measured by bilateral venous occlusion plethysmography. Results: Disease activity of RA was comparably low during both MTX and ENC (DAS 28 3.9±0.3 and 3.5±0.3). FBF in response to ACh was reduced in RA compared to C ( P