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Raadsen R, Dijkshoorn B, van Boheemen L, Ten Boekel E, van Kuijk AWR, Nurmohamed MT. Lipid profile and NT-proBNP changes from pre-clinical to established rheumatoid arthritis: A 12 years follow-up explorative study. Joint Bone Spine 2024; 91:105683. [PMID: 38161051 DOI: 10.1016/j.jbspin.2023.105683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES The aim of the current study was to explore the changes in lipid and NT-proBNP levels in rheumatoid arthritis (RA) patients through different phases of the disease: from the pre-clinical stage and RA onset up to the treatment phase with biological disease-modifying anti-rheumatic drugs (bDMARDS). METHODS Thirty-eight consecutive patients, initially with arthralgia and rheumatoid factor and/or anti-citrullinated protein antibodies without arthritis, who later developed RA and eventually started treatment with bDMARDs, were included. Lipid spectrum and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were measured longitudinally from several months before diagnosis through treatment with bDMARDs. RESULTS From baseline, C-reactive protein (CPR) initially increased sharply, decreasing with the start of biological treatment. Low-density lipoprotein-cholesterol (LDL-c) remained stable, high-density lipoprotein-cholesterol (HDL-c) increased, apolipoprotein A1 (ApoA1 and lipoprotein (a) (Lp(a)), and total cholesterol (TC)/HDL-c ratio and apolipoprotein B (ApoB) decreased during follow-up. NT-proBNP closely followed progression of CRP. TC, LDL-c, TC/HDL-c ratio, ApoA and ApoB inverse correlated with CRP, while Lp(a) positively correlated. HDL-c and triglycerides showed no correlation. CONCLUSION Changes in the lipid profile and NT-proBNP in RA patients seem to be related to inflammation, with changes reflecting an increase in CVD risk occurring along with rises in CRP levels. These changes seem to already be present at diagnosis, indicating the need for timely control of inflammation.
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Affiliation(s)
- Reinder Raadsen
- Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, dr. Jan van Breemenstraat 2, 1056AB Noord-Holland, Netherlands.
| | - Bas Dijkshoorn
- Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, dr. Jan van Breemenstraat 2, 1056AB Noord-Holland, Netherlands
| | - Laurette van Boheemen
- Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, dr. Jan van Breemenstraat 2, 1056AB Noord-Holland, Netherlands
| | - Edwin Ten Boekel
- Northwest Clinics, location Alkmaar, Laboratory for Clinical Chemistry, Department of Hematology and Immunology, Alkmaar, Noord-Holland, Netherlands
| | - Arno W R van Kuijk
- Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, dr. Jan van Breemenstraat 2, 1056AB Noord-Holland, Netherlands
| | - Michael T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, dr. Jan van Breemenstraat 2, 1056AB Noord-Holland, Netherlands; Amsterdam UMC Location VUmc, Department of Rheumatology, Amsterdam, Noord-Holland, Netherlands
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2
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Sanghavi N, Ingrassia JP, Korem S, Ash J, Pan S, Wasserman A. Cardiovascular Manifestations in Rheumatoid Arthritis. Cardiol Rev 2024; 32:146-152. [PMID: 36729119 DOI: 10.1097/crd.0000000000000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disorder that characteristically affects the joints. RA has extra-articular manifestations that can impact multiple organ systems including the heart, lungs, eyes, skin, and brain. Cardiovascular involvement is a leading cause of mortality in RA. Cardiovascular manifestations of RA include accelerated atherosclerosis, heart failure, pericarditis, myocarditis, endocarditis, rheumatoid nodules, and amyloidosis. Inflammation is an important mediator of endothelial dysfunction and is a key driver of cardiovascular risk and complications in patients with RA. Prompt identification of cardiac pathologies in patients with RA is essential for appropriate management and treatment. Choosing the most appropriate treatment regimen is based on individual patient factors. In this article, we provide a comprehensive review of the epidemiology, pathophysiology, clinical manifestations, diagnosis, and medical management of cardiovascular manifestations of RA. We also discuss the relationship between anti-rheumatic medications, specifically non-steroidal anti-inflammatory drugs, corticosteroids, methotrexate, statins, tumor necrosis factor inhibitors, interleukin-6 inhibitors, Janus kinase inhibitors, and cardiovascular disease.
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Affiliation(s)
- Nirali Sanghavi
- From the Department of Medicine, Westchester Medical Center, Valhalla, NY
| | | | - Sindhuja Korem
- Department of Rheumatology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Julia Ash
- Department of Rheumatology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Amy Wasserman
- Department of Rheumatology, Westchester Medical Center/New York Medical College, Valhalla, NY
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3
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Dubiel-Braszczok B, Nowak K, Owczarek A, Engelmann M, Gumkowska-Sroka O, Kotyla PJ. Differential impact of biologic therapy on heart function biomarkers in rheumatoid arthritis patients: Observational study on etanercept, adalimumab and tocilizumab. Curr Pharm Des 2022; 28:2029-2037. [PMID: 35638285 DOI: 10.2174/1381612828666220527141532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/30/2022] [Indexed: 11/22/2022]
Abstract
Background Rheumatoid arthritis (RA) represents the most frequent form of inflammatory arthritis affecting approximately 1% of the population worldwide. Introduction of novel therapeutic strategies targeting proinflammatory cytokines (TNF-α and interleukin-6) revolutionized the treatment of RA. This kind of treatment, although effective in a substantial portion of patients, may potentially cause many side effects. Among them cardiovascular safety is one of the main concerns. Objectives In the present study, we investigated what impact treatment with anti-TNF-α and anti-IL-6 agents may have on heart function and levels of heart function biomarkers Methods To measure this, we used cardiac function biomarkers such as NT-pro Brain Natriuretic Peptide, mid regional pro Atrial Natriuretic Peptide, Galectin-3 and Heart-Type Fatty Acid-Binding Protein and compared them to patients treated with methotrexate as well as healthy controls. Results Patients treated with biologics were characterized by low disease activity or were in remission. The disease activity in these groups were significantly lower in comparison to the methotrexate group. All patient recruited to the study were characterized by normal heart function measured with the use of echocardiography (EF>50%). With the exception of MR-proANP between tocilizumab and adalimumab (median: 1.01 vs 0.49 nmol/L, p < 0.05), we failed to observe any significant differences in biomarkers levels between groups treated with biologics. Contrary to this, patients on MTX showed higher NT-proBNP levels compared to adalimumab, and healthy controls (p < 0.05 for both). Striking differences have been shown in regard to H-FABP. The levels of these biomarkers were elevated in all biologics and the methotrexate group as compared to healthy controls. Conclusion As this biomarker reflects potential heart injury we suggest that heart damage proceeds in continuous manner in RA patients despite effective treatment and attainment of remission/low disease activity. This finding however should be verify in larger cohort of RA patients to ascertain if routine assessment of H-FABP may be useful for detection of patients with RA who are at risk of development of heart damage.
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Affiliation(s)
- Beata Dubiel-Braszczok
- Department of Internal Medicine, Rheumatology and Clinical Immunology Faculty of Medicine in Katowice Medical University of Silesia, Katowice, Poland
| | - Karolina Nowak
- Department of Internal Medicine, Rheumatology and Clinical Immunology Faculty of Medicine in Katowice Medical University of Silesia, Katowice, Poland
| | - Aleksander Owczarek
- Department of Pathophysiology, Health Promotion and Obesity Management Unit Faculty of Medicine in Katowice Medical University of Silesia, Katowice, Poland
| | - Małgorzata Engelmann
- Department of Physiotherapy in Internal Medicine Academy of Physical Education in Katowice, Poland
| | | | - Przemysław J Kotyla
- Department of Internal Medicine, Rheumatology and Clinical Immunology Faculty of Medicine in Katowice Medical University of Silesia, Katowice, Poland
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4
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Colaco K, Lee KA, Akhtari S, Winer R, Welsh P, Sattar N, McInnes IB, Chandran V, Harvey P, Cook RJ, Gladman DD, Piguet V, Eder L. Association of Cardiac Biomarkers With Cardiovascular Outcomes in Patients With Psoriatic Arthritis and Psoriasis: A Longitudinal Cohort Study. Arthritis Rheumatol 2022; 74:1184-1192. [PMID: 35261189 PMCID: PMC9545279 DOI: 10.1002/art.42079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/08/2021] [Accepted: 01/25/2022] [Indexed: 11/20/2022]
Abstract
Objective In patients with psoriatic disease (PsD), we determined whether cardiac troponin I (cTnI) and N‐terminal pro–brain natriuretic peptide (NT‐proBNP) were associated with carotid plaque burden and the development of cardiovascular events independent of the Framingham Risk Score (FRS). Methods Among 1,000 patients with PsD, carotid total plaque area (TPA) was measured in 358 participants at baseline. Cardiac troponin I and NT‐proBNP were measured using automated clinical assays. The association between cardiac biomarkers and carotid atherosclerosis was assessed by multivariable regression after adjusting for cardiovascular risk factors. Improvement in the prediction of cardiovascular events beyond the FRS was tested using measures of risk discrimination and reclassification. Results In univariate analyses, cTnI (β coefficient 0.52 [95% confidence interval (95% CI) 0.3, 0.74], P < 0.001) and NT‐proBNP (β coefficient 0.24 [95% CI 0.1, 0.39], P < 0.001) were associated with TPA. After adjusting for cardiovascular risk factors, the association remained statistically significant for cTnI (adjusted β coefficient 0.21 [95% CI 0, 0.41], P = 0.047) but not for NT‐proBNP (P = 0.21). Among the 1,000 patients with PsD assessed for cardiovascular risk prediction, 64 patients had incident cardiovascular events. When comparing a base model (with the FRS alone) to expanded models (with the FRS plus cardiac biomarkers), there was no improvement in predictive performance. Conclusion In patients with PsD, cTnI may reflect the burden of atherosclerosis, independent of traditional cardiovascular risk factors. Cardiac troponin I and NT‐proBNP are associated with incident cardiovascular events independent of the FRS, but further study of their role in cardiovascular risk stratification is warranted.
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Affiliation(s)
- Keith Colaco
- Women's College Hospital, University of Toronto, and University Health Network, Toronto, Ontario, Canada
| | - Ker-Ai Lee
- University of Waterloo, Waterloo, Ontario, Canada
| | - Shadi Akhtari
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Raz Winer
- Rambam Health Care Campus, Haifa, Israel
| | | | | | | | - Vinod Chandran
- University of Toronto and University Health Network Toronto, Ontario, Canada
| | - Paula Harvey
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Dafna D Gladman
- University of Toronto and University Health Network Toronto, Ontario, Canada
| | - Vincent Piguet
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Lihi Eder
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
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5
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Pusztai A, Hamar A, Horváth Á, Gulyás K, Végh E, Bodnár N, Kerekes G, Czókolyová M, Szamosi S, Bodoki L, Hodosi K, Domján A, Nagy G, Szöllősi I, Lopez LR, Matsuura E, Prohászka Z, Szántó S, Nagy Z, Shoenfeld Y, Szekanecz Z, Szűcs G. Soluble Vascular Biomarkers in Rheumatoid Arthritis and Ankylosing Spondylitis: Effects of 1-year Antitumor Necrosis Factor-α Therapy. J Rheumatol 2020; 48:821-828. [PMID: 33323530 DOI: 10.3899/jrheum.200916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have been associated with cardiovascular disease. The treatment of arthritis by tumor necrosis factor-α (TNF-α) inhibitors may decrease the serum concentrations of vascular biomarkers. We determined circulating levels of oxidized low-density lipoprotein (oxLDL)/β2 glycoprotein I (β2-GPI) complexes, antibodies to 60 kDa heat shock protein (anti-Hsp60), soluble urokinase plasminogen activator receptor (suPAR), and B-type natriuretic peptide (BNP) fragment in sera of RA and AS patients undergoing anti-TNF treatment. METHODS Fifty-three patients with RA/AS were treated with etanercept or certolizumab pegol for 1 year. Circulating oxLDL/β2-GPI complex (AtherOx), anti-Hsp60 IgG, and BNP8-29 fragment levels were assessed by ELISA. suPAR levels were determined by suPARnostic Quick Triage test. Flow-mediated vasodilation (FMD), carotid intima-media thickness (CIMT), and arterial pulse wave velocity (PWV) were determined by ultrasound. RESULTS One-year anti-TNF treatment significantly decreased oxLDL/β2-GPI levels, as well as suPAR levels in patients with critically high suPAR levels at baseline. In RA, BNP levels were higher in seropositive vs seronegative patients. Serum levels of these vascular biomarkers variably correlated with lipids, anticitrullinated protein antibodies, rheumatoid factor, and C-reactive protein. CIMT positively correlated with BNP, and PWV with suPAR and anti-Hsp60, whereas FMD inversely associated with anti-Hsp60. In repeated measures ANOVA analysis, disease activity supported the effects of anti-TNF treatment on 12-month changes in oxLDL/β2-GPI. CIMT supported the effects of therapy on changes in anti-Hsp60 and suPAR. CONCLUSION These biomarkers may be involved in the pathogenesis of atherosclerosis underlying RA/AS. TNF inhibition variably affects the serum levels of oxLDL/β2-GPI, suPAR, and BNP.
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Affiliation(s)
- Anita Pusztai
- A. Pusztai, A. Hamar, MD, Á. Horváth, MD, K. Gulyás, MD, E. Végh, MD, N. Bodnár, MD, PhD, M. Czókolyová, S. Szamosi, MD, PhD, L. Bodoki, MD, PhD, K. Hodosi, A. Domján, Z. Nagy, MD, PhD, Z. Szekanecz, MD, PhD, G. Szűcs, MD, PhD, Division of Rheumatology, Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Hamar
- A. Pusztai, A. Hamar, MD, Á. Horváth, MD, K. Gulyás, MD, E. Végh, MD, N. Bodnár, MD, PhD, M. Czókolyová, S. Szamosi, MD, PhD, L. Bodoki, MD, PhD, K. Hodosi, A. Domján, Z. Nagy, MD, PhD, Z. Szekanecz, MD, PhD, G. Szűcs, MD, PhD, Division of Rheumatology, Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ágnes Horváth
- A. Pusztai, A. Hamar, MD, Á. Horváth, MD, K. Gulyás, MD, E. Végh, MD, N. Bodnár, MD, PhD, M. Czókolyová, S. Szamosi, MD, PhD, L. Bodoki, MD, PhD, K. Hodosi, A. Domján, Z. Nagy, MD, PhD, Z. Szekanecz, MD, PhD, G. Szűcs, MD, PhD, Division of Rheumatology, Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Katalin Gulyás
- A. Pusztai, A. Hamar, MD, Á. Horváth, MD, K. Gulyás, MD, E. Végh, MD, N. Bodnár, MD, PhD, M. Czókolyová, S. Szamosi, MD, PhD, L. Bodoki, MD, PhD, K. Hodosi, A. Domján, Z. Nagy, MD, PhD, Z. Szekanecz, MD, PhD, G. Szűcs, MD, PhD, Division of Rheumatology, Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Edit Végh
- A. Pusztai, A. Hamar, MD, Á. Horváth, MD, K. Gulyás, MD, E. Végh, MD, N. Bodnár, MD, PhD, M. Czókolyová, S. Szamosi, MD, PhD, L. Bodoki, MD, PhD, K. Hodosi, A. Domján, Z. Nagy, MD, PhD, Z. Szekanecz, MD, PhD, G. Szűcs, MD, PhD, Division of Rheumatology, Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Nóra Bodnár
- A. Pusztai, A. Hamar, MD, Á. Horváth, MD, K. Gulyás, MD, E. Végh, MD, N. Bodnár, MD, PhD, M. Czókolyová, S. Szamosi, MD, PhD, L. Bodoki, MD, PhD, K. Hodosi, A. Domján, Z. Nagy, MD, PhD, Z. Szekanecz, MD, PhD, G. Szűcs, MD, PhD, Division of Rheumatology, Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - György Kerekes
- G. Kerekes, MD, PhD, Intensive Care Unit, Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Monika Czókolyová
- A. Pusztai, A. Hamar, MD, Á. Horváth, MD, K. Gulyás, MD, E. Végh, MD, N. Bodnár, MD, PhD, M. Czókolyová, S. Szamosi, MD, PhD, L. Bodoki, MD, PhD, K. Hodosi, A. Domján, Z. Nagy, MD, PhD, Z. Szekanecz, MD, PhD, G. Szűcs, MD, PhD, Division of Rheumatology, Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Szilvia Szamosi
- A. Pusztai, A. Hamar, MD, Á. Horváth, MD, K. Gulyás, MD, E. Végh, MD, N. Bodnár, MD, PhD, M. Czókolyová, S. Szamosi, MD, PhD, L. Bodoki, MD, PhD, K. Hodosi, A. Domján, Z. Nagy, MD, PhD, Z. Szekanecz, MD, PhD, G. Szűcs, MD, PhD, Division of Rheumatology, Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Levente Bodoki
- A. Pusztai, A. Hamar, MD, Á. Horváth, MD, K. Gulyás, MD, E. Végh, MD, N. Bodnár, MD, PhD, M. Czókolyová, S. Szamosi, MD, PhD, L. Bodoki, MD, PhD, K. Hodosi, A. Domján, Z. Nagy, MD, PhD, Z. Szekanecz, MD, PhD, G. Szűcs, MD, PhD, Division of Rheumatology, Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Katalin Hodosi
- A. Pusztai, A. Hamar, MD, Á. Horváth, MD, K. Gulyás, MD, E. Végh, MD, N. Bodnár, MD, PhD, M. Czókolyová, S. Szamosi, MD, PhD, L. Bodoki, MD, PhD, K. Hodosi, A. Domján, Z. Nagy, MD, PhD, Z. Szekanecz, MD, PhD, G. Szűcs, MD, PhD, Division of Rheumatology, Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Andrea Domján
- A. Pusztai, A. Hamar, MD, Á. Horváth, MD, K. Gulyás, MD, E. Végh, MD, N. Bodnár, MD, PhD, M. Czókolyová, S. Szamosi, MD, PhD, L. Bodoki, MD, PhD, K. Hodosi, A. Domján, Z. Nagy, MD, PhD, Z. Szekanecz, MD, PhD, G. Szűcs, MD, PhD, Division of Rheumatology, Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gábor Nagy
- G. Nagy, MD, PhD, I. Szöllősi, Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary
| | - Ibolya Szöllősi
- G. Nagy, MD, PhD, I. Szöllősi, Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary
| | - Luis R Lopez
- L.R. Lopez, MD, PhD, Corgenix Inc., Broomfield, Colorado, USA
| | - Eiji Matsuura
- E. Matsuura, MD, PhD, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Zoltán Prohászka
- Z. Prohászka, MD, PhD, Third Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Sándor Szántó
- S. Szántó, MD, PhD, Division of Rheumatology, Department of Medicine, and Department of Sports Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Nagy
- A. Pusztai, A. Hamar, MD, Á. Horváth, MD, K. Gulyás, MD, E. Végh, MD, N. Bodnár, MD, PhD, M. Czókolyová, S. Szamosi, MD, PhD, L. Bodoki, MD, PhD, K. Hodosi, A. Domján, Z. Nagy, MD, PhD, Z. Szekanecz, MD, PhD, G. Szűcs, MD, PhD, Division of Rheumatology, Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Yehuda Shoenfeld
- Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Zoltán Szekanecz
- A. Pusztai, A. Hamar, MD, Á. Horváth, MD, K. Gulyás, MD, E. Végh, MD, N. Bodnár, MD, PhD, M. Czókolyová, S. Szamosi, MD, PhD, L. Bodoki, MD, PhD, K. Hodosi, A. Domján, Z. Nagy, MD, PhD, Z. Szekanecz, MD, PhD, G. Szűcs, MD, PhD, Division of Rheumatology, Department of Medicine, University of Debrecen, Debrecen, Hungary;
| | - Gabriella Szűcs
- A. Pusztai, A. Hamar, MD, Á. Horváth, MD, K. Gulyás, MD, E. Végh, MD, N. Bodnár, MD, PhD, M. Czókolyová, S. Szamosi, MD, PhD, L. Bodoki, MD, PhD, K. Hodosi, A. Domján, Z. Nagy, MD, PhD, Z. Szekanecz, MD, PhD, G. Szűcs, MD, PhD, Division of Rheumatology, Department of Medicine, University of Debrecen, Debrecen, Hungary
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Drakopoulou M, Soulaidopoulos S, Oikonomou G, Tousoulis D, Toutouzas K. Cardiovascular Effects of Biologic Disease-Modifying Anti-Rheumatic Drugs (DMARDs). Curr Vasc Pharmacol 2020; 18:488-506. [PMID: 32056527 DOI: 10.2174/1570161118666200214115532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 01/07/2023]
Abstract
The risk of cardiovascular (CV) disease is increased among patients with systemic autoimmune rheumatic diseases and remains an underserved area of medical need. Although traditional risk factors for CV disease, such as hypertension, smoking, dyslipidemia and obesity contribute to endothelial dysfunction in rheumatoid arthritis (RA), they are not enough on their own to explain the observed excess CV risk. Rather, systemic inflammation seems to play a pivotal role in both disease states. Considering the inflammatory process in autoimmune diseases, scientific interest has focused on recently introduced biologic disease-modifying agents (bDMARDS) such as inhibitors of Tumor Necrosis Factor- α (ΤΝF-α), Interleukins -1 (IL-1) and -6 (IL-6). Despite the widespread use of bDMARDS in RA and other chronic autoimmune inflammatory diseases, their precise impact on CV disease and outcome remains to be elucidated, while prospective randomized control trials assessing their impact on hard CV endpoints are scarce. In this review, we summarize current knowledge concerning the effect of bDMARDs on CV outcome and on the risk of developing CV disease in patients with systemic autoimmune rheumatic diseases.
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Affiliation(s)
- Maria Drakopoulou
- First Department of Cardiology, Athens School of Medicine, Hippokration Hospital, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, Athens School of Medicine, Hippokration Hospital, Athens, Greece
| | - George Oikonomou
- First Department of Cardiology, Athens School of Medicine, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Athens School of Medicine, Hippokration Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, Athens School of Medicine, Hippokration Hospital, Athens, Greece
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7
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Baniaamam M, Handoko ML, Agca R, Heslinga SC, Konings TC, van Halm VP, Nurmohamed MT. The Effect of Anti-TNF Therapy on Cardiac Function in Rheumatoid Arthritis: An Observational Study. J Clin Med 2020; 9:jcm9103145. [PMID: 33003318 PMCID: PMC7600361 DOI: 10.3390/jcm9103145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 01/08/2023] Open
Abstract
Congestive heart failure (CHF) is the second most prevalent cause of death in rheumatoid arthritis (RA). The systemic inflammatory state in RA patients is deemed responsible for this finding. Anti-inflammatory treatment with anti-tumor necrosis factor (anti-TNF) therapy decreases CV risk and subsequently might improve the cardiac function by lowering the overall inflammatory state. This study investigated the effect of anti-TNF on the cardiac function in RA patients. Fifty one RA patients were included, of which thirty three completed follow-up. Included patients were >18 years, had moderate-high disease activity and no history of cardiac disease. Patients were assessed at baseline and after six months of anti-TNF treatment. Patients underwent conventional Speckle tracking and tissue Doppler echocardiography in combination with clinical and laboratory assessments at baseline and follow-up. The left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) showed no changes during follow-up, LVEF 63% (±9) to 62% (±8) p = 0.097 and GLS -20 (±4) to -20 (±3) p = 0.79, respectively. Furthermore, E/e' nor E/A changed significantly between baseline and follow-up, respectively 8 (7-9) and 8 (7-9) p = 0.17 and 1.1 (±0.4) and 1.1 (±0.4) p = 0.94. Follow-up NT-proBNP decreased with 23%, from 89 ng/L (47-142) to 69 ng/L (42-155), p = 0.10. Regression analysis revealed no association between change in inflammatory variables and cardiac function. Echocardiography showed no effect of anti-TNF treatment on the cardiac function in RA patients with low prevalence of cardiac dysfunction. Moreover, NT-proBNP decreased, possibly indicating (subtle) improvement of the cardiac function.
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Affiliation(s)
- Milad Baniaamam
- Amsterdam Rheumatology Immunology Center, Location Reade, 1056 AB Amsterdam, The Netherlands; (R.A.); (S.C.H.); (M.T.N.)
- Amsterdam Cardiovascular Sciences, Vrije Universiteit, 1081 HZ Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-20-242-1808
| | - M. Louis Handoko
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.L.H.); (T.C.K.); (V.P.v.H.)
| | - Rabia Agca
- Amsterdam Rheumatology Immunology Center, Location Reade, 1056 AB Amsterdam, The Netherlands; (R.A.); (S.C.H.); (M.T.N.)
- Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Sjoerd C. Heslinga
- Amsterdam Rheumatology Immunology Center, Location Reade, 1056 AB Amsterdam, The Netherlands; (R.A.); (S.C.H.); (M.T.N.)
- Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Thelma C. Konings
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.L.H.); (T.C.K.); (V.P.v.H.)
| | - Vokko P. van Halm
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.L.H.); (T.C.K.); (V.P.v.H.)
| | - Mike T. Nurmohamed
- Amsterdam Rheumatology Immunology Center, Location Reade, 1056 AB Amsterdam, The Netherlands; (R.A.); (S.C.H.); (M.T.N.)
- Amsterdam Cardiovascular Sciences, Vrije Universiteit, 1081 HZ Amsterdam, The Netherlands
- Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
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8
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Packer M, Lam CS, Lund LH, Maurer MS, Borlaug BA. Characterization of the inflammatory-metabolic phenotype of heart failure with a preserved ejection fraction: a hypothesis to explain influence of sex on the evolution and potential treatment of the disease. Eur J Heart Fail 2020; 22:1551-1567. [PMID: 32441863 PMCID: PMC7687188 DOI: 10.1002/ejhf.1902] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/05/2020] [Accepted: 05/17/2020] [Indexed: 12/11/2022] Open
Abstract
Accumulating evidence points to the existence of an inflammatory-metabolic phenotype of heart failure with a preserved ejection fraction (HFpEF), which is characterized by biomarkers of inflammation, an expanded epicardial adipose tissue mass, microvascular endothelial dysfunction, normal-to-mildly increased left ventricular volumes and systolic blood pressures, and possibly, altered activity of adipocyte-associated inflammatory mediators. A broad range of adipogenic metabolic and systemic inflammatory disorders - e.g. obesity, diabetes and metabolic syndrome as well as rheumatoid arthritis and psoriasis - can cause this phenotype, independent of the presence of large vessel coronary artery disease. Interestingly, when compared with men, women are both at greater risk of and may suffer greater cardiac consequences from these systemic inflammatory and metabolic disorders. Women show disproportionate increases in left ventricular filling pressures following increases in central blood volume and have greater arterial stiffness than men. Additionally, they are particularly predisposed to epicardial and intramyocardial fat expansion and imbalances in adipocyte-associated proinflammatory mediators. The hormonal interrelationships seen in inflammatory-metabolic phenotype may explain why mineralocorticoid receptor antagonists and neprilysin inhibitors may be more effective in women than in men with HFpEF. Recognition of the inflammatory-metabolic phenotype may improve an understanding of the pathogenesis of HFpEF and enhance the ability to design clinical trials of interventions in this heterogeneous syndrome.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular InstituteBaylor University Medical CenterDallasTXUSA
- Imperial College LondonLondonUK
| | - Carolyn S.P. Lam
- National Heart Centre Singapore and Duke‐National University of SingaporeSingapore
- University Medical Centre GroningenGroningenThe Netherlands
- The George Institute for Global HealthSydneyAustralia
| | - Lars H. Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular ThemeKarolinska University HospitalStockholmSweden
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9
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NT-proBNP in Rheumatoid Arthritis Patients: Interaction of Immuno-inflammatory Process and Cardiovascular System. Fam Med 2020. [DOI: 10.30841/2307-5112.3.2020.211866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Novikova DS, Udachkina HV, Kirillova IG, Popkova TV. Chronic Heart Failure in Rheumatoid Arthritis Patients (Part III): Effects of Antirheumatic Drugs. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2019-15-6-820-830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chronic autoimmune inflammation is one of the leading risk factors for the development of chronic heart failure (CHF) in rheumatoid arthritis (RA). The purpose of the review is to analyze the results of investigations on the effects of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), biological disease-modifying anti-rheumatic drugs (bDMARDs), and targeted csDMARDs on cardiac function and the risk of developing CHF in patients with RA. Methotrexate may reduce the CHF risk and have a positive effect on the course of this condition in patients with RA. Despite the data on the presence of leflunomide effects that impede myocardial remodeling, there is no evidence of the role of the drug in the prevention of CHF in RA patients. Hydroxychloroquine may contribute to the prevention of CHF, but the risk of developing severe cardiotoxicity should be considered when taking the drug for a long time. Most studies have not revealed the negative effect of tumor necrosis factor inhibitors on the prevalence and incidence of new cases of CHF in RA patients, and an improvement in the structure and function of the heart during therapy has been shown. Inhibitors of interleukin (IL) -1, inhibitors of IL-6, inhibitors of T-cell co-stimulation, anti-B-cell therapy, targeted csDMARDs do not increase the risk of CHF and may have cardioprotective effects, including slowing the progression of left ventricle myocardial dysfunction. Due to the high risk of CHF and CHF-associated mortality in RA patients, early diagnosis of cardiac dysfunction, development of a prevention and treatment strategies are needed, including high-quality prospective studies to assess the effect of anti-rheumatic therapy on myocardial function, risk of developing and decompensation of CHF in RA patients. It is possible that some drugs may possess protective effects on cardiomyocytes so they could become the first-line drugs in patients with CHF or the risk of its development.
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11
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The Giants (biologicals) against the Pigmies (small molecules), pros and cons of two different approaches to the disease modifying treatment in rheumatoid arthritis. Autoimmun Rev 2019; 19:102421. [PMID: 31733368 DOI: 10.1016/j.autrev.2019.102421] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 02/08/2023]
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that, if untreated, can lead to disability and reduce the life expectancy of affected patients. Over the last two decades the improvement of knowledge of the pathogenetic mechanisms leading to the development of the disease has profoundly changed the treatment strategies of RA through the development of biotechnological drugs (bDMARDs) directed towards specific pro-inflammatory targets involved in the RA network. To date, the therapeutic armamentarium for RA includes ten bDMARDs able to produce the depletion B-cells, the blockade of three different pro-inflammatory cytokines (tumour necrosis factor alpha, interleukin-6 and interleukin-1), or the inhibition of T-cell co-stimulation. The introduction of these new compounds has dramatically improved outcomes in the short and long term, although still a significant proportion of patients are unable to reach or maintain the treatment target over time. The identification of the fundamental role of Janus kinases in the process of transduction of the inflammatory signal within the immune cells has recently provided the opportunity to use the new pharmacological class of small molecules for the therapy of RA, further increasing the number of treatment options. In this review the PROS and CONS of these two drug classes will be discussed, trying to provide the evidence currently available to make the right choice based on the analysis of the efficacy and safety profile of the different drugs on the market and close to marketing.
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12
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Balogh E, Pusztai A, Hamar A, Végh E, Szamosi S, Kerekes G, McCormick J, Biniecka M, Szántó S, Szűcs G, Nagy Z, Fearon U, Veale DJ, Szekanecz Z. Autoimmune and angiogenic biomarkers in autoimmune atherosclerosis. Clin Immunol 2019; 199:47-51. [DOI: 10.1016/j.clim.2018.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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Kouvas N, Kontogiannis C, Georgiopoulos G, Spartalis M, Tsilimigras DI, Spartalis E, Kapelouzou A, Kosmopoulos M, Chatzidou S. The complex crosstalk between inflammatory cytokines and ventricular arrhythmias. Cytokine 2018; 111:171-177. [PMID: 30172113 DOI: 10.1016/j.cyto.2018.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 12/23/2022]
Affiliation(s)
- N Kouvas
- Department of Clinical Therapeutics, "Alexandra" Hospital, University of Athens, Athens, Greece
| | - C Kontogiannis
- Department of Clinical Therapeutics, "Alexandra" Hospital, University of Athens, Athens, Greece
| | - G Georgiopoulos
- Department of Clinical Therapeutics, "Alexandra" Hospital, University of Athens, Athens, Greece
| | - M Spartalis
- Department of Electrophysiology and Pacing, Onassis Cardiac Surgery Center, Greece
| | - D I Tsilimigras
- Department of Clinical Therapeutics, "Alexandra" Hospital, University of Athens, Athens, Greece
| | - E Spartalis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Medical School, Greece
| | - A Kapelouzou
- Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - M Kosmopoulos
- Department of Clinical Therapeutics, "Alexandra" Hospital, University of Athens, Athens, Greece.
| | - S Chatzidou
- Department of Clinical Therapeutics, "Alexandra" Hospital, University of Athens, Athens, Greece
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Targońska-Stępniak B, Piotrowski M, Zwolak R, Drelich-Zbroja A, Majdan M. Prospective assessment of cardiovascular risk parameters in patients with rheumatoid arthritis. Cardiovasc Ultrasound 2018; 16:18. [PMID: 30068353 PMCID: PMC6090938 DOI: 10.1186/s12947-018-0136-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/24/2018] [Indexed: 01/08/2023] Open
Abstract
Background The study presents a prospective follow-up assessment of cardiovascular (CV) risk parameters in patients with rheumatoid arthritis (RA) in comparison with control subjects. Methods The study group consisted of 41 RA patients. The following parameters were assessed at subsequent visits [initial (T0), follow-up after 6 years (T6)]: traditional CV risk factors, carotid intima media thickness (cIMT), QTc duration, serum concentration of amino-terminal pro-brain natriuretic peptide (NT-proBNP). A comparative cIMT assessment was performed on 23 healthy controls of comparable age. Results The mean (SD) cIMT value in RA patients was significantly higher at T6 than at T0 [0.87 (0.21) vs 0.76 (0.15) mm, p < 0.001], the increase in patients with atherosclerotic plaques was noted. Patients with plaques were significantly older, had higher inflammatory parameters. The mean cIMT was significantly higher in RA patients than in controls at both T6, T0 visits. Certain traditional CV risk factors exacerbated during follow up. Unfavorable metabolic parameters and significantly higher cIMT were found in male patients than in female patients at T6. During follow-up, no significant differences in NT-proBNP, QTc were found. There were no significant relationships between cIMT, NT-proBNP, QTc and parameters of disease activity at T6. Conclusions During the 6-year course of established RA, significant exacerbation of atherosclerosis was found, revealed by higher cIMT. A careful monitoring should be applied to patients with atherosclerotic plaques and of male gender due to higher burden of CV risk. In long-standing disease, traditional CV risk factors seem to play a key role, beyond the inflammatory activity.
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Affiliation(s)
- Bożena Targońska-Stępniak
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, ul. Jaczewskiego 8, 20-950, Lublin, Poland.
| | - Mariusz Piotrowski
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, ul. Jaczewskiego 8, 20-950, Lublin, Poland
| | - Robert Zwolak
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, ul. Jaczewskiego 8, 20-950, Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, ul. Jaczewskiego 8, 20-950, Lublin, Poland
| | - Maria Majdan
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, ul. Jaczewskiego 8, 20-950, Lublin, Poland
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15
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Yokoe I, Kobayashi H, Kobayashi Y, Giles JT, Yoneyama K, Kitamura N, Takei M. Impact of tocilizumab on N-terminal pro-brain natriuretic peptide levels in patients with active rheumatoid arthritis without cardiac symptoms. Scand J Rheumatol 2018; 47:364-370. [DOI: 10.1080/03009742.2017.1418424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- I Yokoe
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
- Division of Rheumatology, Itabashi Chuo Medical Center, Tokyo, Japan
| | - H Kobayashi
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Y Kobayashi
- Department of Advanced Biomedical Imaging Informatics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - JT Giles
- Division of Rheumatology, Columbia University, College of Physicians and Surgeons, New York, USA
| | - K Yoneyama
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - N Kitamura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - M Takei
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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16
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Li X, Peng H, Wu J, Xu Y. Brain Natriuretic Peptide-Regulated Expression of Inflammatory Cytokines in Lipopolysaccharide (LPS)-Activated Macrophages via NF-κB and Mitogen Activated Protein Kinase (MAPK) Pathways. Med Sci Monit 2018; 24:3119-3126. [PMID: 29754152 PMCID: PMC5973487 DOI: 10.12659/msm.905580] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background This study aimed to investigate the effects of recombinant human brain natriuretic peptide (rhBNP) on IL-6, TNF-α, and IL-10 secretion in LPS-activated RAW 264.7 cells and human peripheral blood mononuclear cells (PBMCs) in vitro and to explore the related signaling pathways of the regulation mechanisms of BNP in systemic inflammatory response syndrome (SIRS). Material/Methods MTT assay was used to evaluate the effects of rhBNP on cell viabilities. Lipopolysaccharide (LPS) was used to induce inflammation response. The whole study was divided into 8 groups: Control, low, middle, and high concentrations of rhBNP, LPS, LPS with low, middle, and high concentrations of rhBNP. Levels of IL-6, TNF-α, and IL-10 were evaluated using the Cytometric Bead Array Kit and RT-PCR assay. Western blotting was used to test the effects of rhBNP on inflammation-related NF-κB and MAPK pathways. Results Except for the concentrations ≥1.6 ng/mL, all concentrations of rhBNP showed little effect on cell viabilities of RAW264.7 cells and PBMCs after 24 h and 48 h, suggesting a weak cytotoxicity to cells. Expression of IL-6 and TNF-α significantly increased and expression of IL-10 significantly decreased at protein and mRNA levels after LPS treatment, and these effects were strongly inhibited in a dose-dependent manner by pretreatment of rhBNP. Similarly, the LPS-induced increase of NF-κB and MAPK pathway phosphorylation levels were also significantly inhibited by rhBNP. Conclusions rhBNP can regulate expression of IL-6, TNF-α, and IL-10 in LPS-activated RAW 264.7 cells and PBMCs through inhibiting NF-κB and MAPK pathways. These results may reveal potential causes of the increase of BNP in SIRS and may provide an experimental basis for treatment of SIRS.
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Affiliation(s)
- Xiong Li
- Department of Burns, Third Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Hao Peng
- Department of Burns, Third Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Jiongxing Wu
- Department of Emergency Medicine, Xiangya Third Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Yangcheng Xu
- Department of Burns, Third Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
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17
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Nurmohamed M, Choy E, Lula S, Kola B, DeMasi R, Accossato P. The Impact of Biologics and Tofacitinib on Cardiovascular Risk Factors and Outcomes in Patients with Rheumatic Disease: A Systematic Literature Review. Drug Saf 2018; 41:473-488. [PMID: 29318514 PMCID: PMC5938314 DOI: 10.1007/s40264-017-0628-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Rheumatic diseases are autoimmune, inflammatory diseases often associated with cardiovascular (CV) disease, a major cause of mortality in these patients. In recent years, treatment with biologic and targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs), either as monotherapy or in combination with other drugs, have become the standard of treatment. In this systematic literature review, we evaluated the effect of treatment with biologic or tofacitinib on the CV risk and outcomes in these patients. METHODS A systematic search was performed in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for articles reporting on CV risk and events in patients with rheumatic disease treated with a biologic agent or tofacitinib. Articles identified were subjected to two levels of screening. Articles that passed the first level based on title and abstract were assessed on full-text evaluation. The quality of randomized clinical trials was assessed by Jadad scoring system and the quality of the other studies and abstracts was assessed using the Downs and Black instrument. The data extracted included study design, baseline patient characteristics, and measurements of CV risk and events. RESULTS Of the 5722 articles identified in the initial search, screening yielded 105 unique publications from 90 unique studies (33 clinical trials, 39 prospective cohort studies, and an additional 18 retrospective studies) that reported CV risk outcomes. A risk of bias analysis for each type of report indicated that they were of good or excellent quality. Importantly, despite some limitations in data reported, there were no indications of significant increase in adverse CV events or risk in response to treatment with the agents evaluated. CONCLUSIONS Treatment with biologic or tofacitinib appears to be well-tolerated with respect to CV outcomes in these patients.
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Affiliation(s)
- Michael Nurmohamed
- Department of Rheumatology, Reade, VU University Medical Center, 3A50, Amsterdam Rheumatology and Immunology Center, Dr. Jan van Breemenstraat 2, 1056 AB, Amsterdam, The Netherlands.
| | - Ernest Choy
- Cardiff University School of Medicine, Cardiff, Wales, UK
| | - Sadiq Lula
- Envision Pharma Group, London, UK
- IQVIA, London, UK
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Baniaamam M, Paulus WJ, Blanken AB, Nurmohamed MT. The effect of biological DMARDs on the risk of congestive heart failure in rheumatoid arthritis: a systematic review. Expert Opin Biol Ther 2018; 18:585-594. [DOI: 10.1080/14712598.2018.1462794] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Milad Baniaamam
- Amsterdam Rheumatology Immunology Center, Amsterdam, the Netherlands
- Department of Rheumatology, Jan van Breemen Research Institute/Reade, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, VUmc/Reade/AMC/Sanquin, Amsterdam, the Netherlands
| | - Walter J. Paulus
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Annelies B. Blanken
- Amsterdam Rheumatology Immunology Center, Amsterdam, the Netherlands
- Department of Rheumatology, Jan van Breemen Research Institute/Reade, Amsterdam, the Netherlands
| | - Michael T. Nurmohamed
- Amsterdam Rheumatology Immunology Center, Amsterdam, the Netherlands
- Department of Rheumatology, Jan van Breemen Research Institute/Reade, Amsterdam, the Netherlands
- Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands
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19
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Welsh P, Grassia G, Botha S, Sattar N, Maffia P. Targeting inflammation to reduce cardiovascular disease risk: a realistic clinical prospect? Br J Pharmacol 2017; 174:3898-3913. [PMID: 28409825 PMCID: PMC5660005 DOI: 10.1111/bph.13818] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 12/16/2022] Open
Abstract
Data from basic science experiments is overwhelmingly supportive of the causal role of immune-inflammatory response(s) at the core of atherosclerosis, and therefore, the theoretical potential to manipulate the inflammatory response to prevent cardiovascular events. However, extrapolation to humans requires care and we still lack definitive evidence to show that interfering in immune-inflammatory processes may safely lessen clinical atherosclerosis. In this review, we discuss key therapeutic targets in the treatment of vascular inflammation, placing basic research in a wider clinical perspective, as well as identifying outstanding questions. LINKED ARTICLES This article is part of a themed section on Targeting Inflammation to Reduce Cardiovascular Disease Risk. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.22/issuetoc and http://onlinelibrary.wiley.com/doi/10.1111/bcp.v82.4/issuetoc.
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Affiliation(s)
- Paul Welsh
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Gianluca Grassia
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Shani Botha
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom campus, South Africa
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Pasquale Maffia
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.,Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.,Department of Pharmacy, University of Naples Federico II, Naples, Italy
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20
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Welsh P, Tuckwell K, McInnes IB, Sattar N. Effect of IL-6 receptor blockade on high-sensitivity troponin T and NT-proBNP in rheumatoid arthritis. Atherosclerosis 2016; 254:167-171. [PMID: 27744141 PMCID: PMC5110649 DOI: 10.1016/j.atherosclerosis.2016.10.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/04/2016] [Accepted: 10/07/2016] [Indexed: 12/05/2022]
Abstract
Background and aims Observational associations between inflammation and cardiovascular disease are interesting, but randomised experimental data are lacking. We investigated the effect of the IL-6 receptor blocker tocilizumab on N terminal pro B type natriuretic peptide (NT-proBNP) and high sensitivity troponin T (hsTnT) in rheumatoid arthritis (RA) patients. Methods A post-hoc study was performed in a subset of patients with moderate to severe RA participating in a randomised controlled trial. The effect of tocilizumab on cardiac biomarkers was determined using stored serum (baseline and 24 weeks) in recipients of tocilizumab (8 mg/kg every 4 weeks plus DMARDs; n = 225) or placebo (every 4 weeks plus DMARDs; n = 132). Results Median NT-proBNP and hsTnT concentrations at baseline were 100 pg/ml and 5.7 pg/ml, respectively. NT-proBNP decreased in both study arms (median at 24 weeks 77 pg/ml in the placebo arm, 79 pg/ml in the tocilizumab arm; p<0.001 for the decrease in both arms), and decreased to a similar extent comparing study arms (tocilizumab effect: −5.5%, p=0.55). hsTnT also decreased in both study arms (median at 24 weeks 3.1 pg/ml in the placebo arm, 4.4 pg/ml in the tocilizumab arm; p<0.001 for the decrease in both arms). The extent of the reduction in hsTnT was greater in the placebo group (tocilizumab effect: +23.3%, p=0.002). Change in NT-proBNP, but not hsTnT, correlated modestly with change in CRP (r = 0.17, p=0.013). Conclusions These data argue against a rapid preferential benefit of IL-6 blockade on these specific surrogate markers of cardiovascular risk, but may be consistent with a general cardiovascular benefit of improved RA treatment. Clinical trials.gov identifier NCT00106574. Tocilizumab treatment was associated with a decrease in NT-proBNP, similar in magnitude to the decrease in the placebo arm. Troponin T also decreased in both study arms, but decreased slightly more in the placebo arm. These data do not support a rapid preferential benefit of tocilizumab treatment on cardiac biomarkers. These data may be consistent with the view that improved treatment of rheumatoid arthritis might reduce cardiovascular disease risk.
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Affiliation(s)
- Paul Welsh
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
| | | | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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21
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Bissell LA, Hensor EMA, Kozera L, Mackie SL, Burska AN, Nam JL, Keen H, Villeneuve E, Donica H, Buch MH, Conaghan PG, Andrews J, Emery P, Morgan AW. Improvement in insulin resistance is greater when infliximab is added to methotrexate during intensive treatment of early rheumatoid arthritis-results from the IDEA study. Rheumatology (Oxford) 2016; 55:2181-2190. [PMID: 27638812 DOI: 10.1093/rheumatology/kew306] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 07/15/2016] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To determine the change in established biomarkers of cardiovascular (CV) risk, namely, total cholesterol/high-density lipoprotein cholesterol ratio (TC/HDL-C), N-terminal pro-brain natriuretic peptide (NT-proBNP) and insulin resistance (IR) in patients with early RA treated with two different treat-to-target strategies. METHODS Fasting glucose, lipids, insulin and NT-proBNP were measured at baseline, weeks 26 and 78 in 79 DMARD-naïve RA patients, free of CV disease, as part of a double-blind randomized controlled trial of MTX with either infliximab (IFX) or methylprednisolone as induction therapy. Homeostasis model assessment-estimated IR (HOMA-IR) (glucose*insulin/405) was used to measure IR. Multiple imputation was employed, and linear regression analyses were adjusted for baseline values. RESULTS Changes in DAS44-CRP did not differ between the treatment arms at weeks 26 and 78. Mean TC/HDL-C, HOMA-IR and NT-proBNP improved in both groups at weeks 26 and 78, although change in NT-proBNP was not statistically significant at week 78. Changes in TC/HDL-C and NT-proBNP were similar between treatment arms, but HOMA-IR values in the IFX + MTX arm were 42% lower than those treated with MTX + methylprednisolone at week 78 (P = 0.003); the difference remained significant after adjustment for baseline BMI, ACPA positivity, smoking status and intramuscular glucocorticoid use (P = 0.007). CONCLUSION When implementing a treat-to-target approach, treatment of early RA was associated with improvement in TC/HDL-C, HOMA-IR and NT-proBNP, and a greater long-term improvement in HOMA-IR was seen in those treated with IFX. TRIAL REGISTRATION EU Clinical Trials Register, http://www.clinicaltrialsregister.eu, Eudract-2005-005013-37; ISRTCNregisrty, http://www.isrctn.com, ISRCTN48638981.
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Affiliation(s)
- Lesley-Anne Bissell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds & NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Elizabeth M A Hensor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds & NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lukasz Kozera
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds & NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Faculty of Pharmacy, Wroclaw Medical University, Wroclaw
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds & NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Agata N Burska
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds & NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jacqueline L Nam
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds & NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Helen Keen
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds & NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Edith Villeneuve
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds & NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Helena Donica
- Department of Biochemical Diagnostics, Medical University of Lublin, Lublin, Poland
| | - Maya H Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds & NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds & NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jacqueline Andrews
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds & NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds & NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ann W Morgan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds & NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK,
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22
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Lazúrová I, Tomáš Ľ. Cardiac Impairment in Rheumatoid Arthritis and Influence of Anti-TNFα Treatment. Clin Rev Allergy Immunol 2016; 52:323-332. [DOI: 10.1007/s12016-016-8566-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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23
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Straub RH, Ehrenstein B, Günther F, Rauch L, Trendafilova N, Boschiero D, Grifka J, Fleck M. Increased extracellular water measured by bioimpedance and by increased serum levels of atrial natriuretic peptide in RA patients-signs of volume overload. Clin Rheumatol 2016; 36:1041-1051. [PMID: 27112146 DOI: 10.1007/s10067-016-3286-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 04/15/2016] [Accepted: 04/16/2016] [Indexed: 01/08/2023]
Abstract
The aim of the study is to investigate water compartments in patients with rheumatoid arthritis (RA). Acute inflammatory episodes such as infection stimulate water retention, chiefly implemented by the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis. This is an important compensatory mechanism due to expected water loss (sweating etc.). Since SNS and HPA axis are activated in RA, inflammation might be accompanied by water retention. Using bioimpedance analysis, body composition was investigated in 429 controls and 156 treatment-naïve RA patients between January 2008 and December 2014. A group of 34 RA patients was tested before and after 10 days of intensified therapy. Levels of pro-atrial natriuretic peptide (proANP) and expression of atrial natriuretic peptide in synovial tissue were investigated in 15 controls and 14 RA patients. Extracellular water was higher in RA patients than controls (mean ± SEM: 49.5 ± 0.3 vs. 36.7 ± 0.1, % of total body water, p < 0.0001). Plasma levels of proANP were higher in RA than controls. RA patients expressed ANP in synovial tissue, but synovial fluid levels and synovial tissue superfusate levels were much lower than plasma levels indicating systemic origin. Systolic/diastolic blood pressure was higher in RA patients than controls. Extracellular water levels did not change in RA patients despite 10 days of intensified treatment. This study demonstrates signs of intravascular overload in RA patients. Short-term intensification of anti-inflammatory therapy induced no change of a longer-lasting imprinting of water retention indicating the requirement of additional treatment. The study can direct attention to the area of volume overload.
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Affiliation(s)
- Rainer H Straub
- Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine, University Hospital Regensburg, 93042, Regensburg, Germany.
| | - Boris Ehrenstein
- Department of Rheumatology and Clinical Immunology, Asklepios Medical Center Bad Abbach, Bad Abbach, Germany
| | - Florian Günther
- Department of Rheumatology and Clinical Immunology, Asklepios Medical Center Bad Abbach, Bad Abbach, Germany
| | - Luise Rauch
- Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine, University Hospital Regensburg, 93042, Regensburg, Germany
| | - Nadezhda Trendafilova
- Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine, University Hospital Regensburg, 93042, Regensburg, Germany
| | | | - Joachim Grifka
- Department of Orthopedic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Martin Fleck
- Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine, University Hospital Regensburg, 93042, Regensburg, Germany.,Department of Rheumatology and Clinical Immunology, Asklepios Medical Center Bad Abbach, Bad Abbach, Germany
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24
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Jandali B, Tang WHW, Husni E. Heart Failure and Inflammatory Arthritis: the Relationship of Systemic Inflammation. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Shen J, Shang Q, Tam LS. Targeting inflammation in the prevention of cardiovascular disease in patients with inflammatory arthritis. Transl Res 2016; 167:138-51. [PMID: 26051628 DOI: 10.1016/j.trsl.2015.05.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 12/15/2022]
Abstract
Patients with inflammatory arthritis have increased risk of cardiovascular diseases (CVDs) compared with the general population. Subclinical carotid atherosclerosis and increased arterial stiffness are also common in these patients, which may serve as surrogate end points for cardiovascular (CV) events in clinical trials. Although exact mechanisms are still unclear, persistent systemic inflammation in patients with inflammatory arthritis may contribute to the development of CVD. Dysregulated innate immunity pathways in these patients may also play a role in accelerating atherosclerosis. During the last decade, effective suppression of inflammation by biological disease-modifying antirheumatic drugs has improved the disease outcome dramatically in patients with inflammatory arthritis. Growing evidence suggests that antitumor necrosis factor (TNF) therapy may prevent CVD in patients with rheumatoid arthritis. Nonetheless, data on non-TNF biologics are limited. Whether anti-TNF therapy may prevent CVD in patients with spondyloarthritis also remained unclear. In this review, we summarized the effect of both anti-TNF and non-TNF biologics on the CV system, including traditional CVD risk factors, endothelial function, arterial stiffness, subclinical atherosclerosis, and clinical CVD in patients with inflammatory arthritis.
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Affiliation(s)
- Jiayun Shen
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Qing Shang
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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26
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Kirillova IG, Novikova DS, Popkova TV, Aleksandrova EN, Novikov AA, Gorbunova YN, Markelova EI, Korsakova YO, Glukhova SI, Volkov AV, Luchikhina EL, Demidova NV, Kasumova KA, Vladimirov SA, Kanonirova MA, Lukina GL, Karateev DE, Nasonov EL. N-terminal pro-brain natriuretic peptide levels and diastolic dysfunction in patients with early rheumatoid arthritis before the administration of disease-modifying antirheumatic drugs. TERAPEVT ARKH 2016; 88:19-26. [DOI: 10.17116/terarkh201688519-26] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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27
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Lappegård KT, Bjørnstad H, Mollnes TE, Hovland A. Effect of Cardiac Resynchronization Therapy on Inflammation in Congestive Heart Failure: A Review. Scand J Immunol 2015; 82:191-8. [PMID: 26099323 DOI: 10.1111/sji.12328] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/16/2015] [Indexed: 11/30/2022]
Abstract
Congestive heart failure is associated with increased levels of several inflammatory mediators, and animal studies have shown that infusion of a number of cytokines can induce heart failure. However, several drugs with proven efficacy in heart failure have failed to affect inflammatory mediators, and anti-inflammatory therapy in heart failure patients has thus far been disappointing. Hence, to what extent heart failure is caused by or responsible for the increased inflammatory burden in the patient is still unclear. Over the past couple of decades, resynchronization therapy with a biventricular pacemaker has emerged as an effective treatment in a subset of heart failure patients, reducing both morbidity and mortality. Such treatment has also been shown to affect the inflammation associated with heart failure. In this study, we review recent data on the association between heart failure and inflammation, and in particular how resynchronization therapy can affect the inflammatory process.
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Affiliation(s)
- K T Lappegård
- Cardiac Care Unit, Division of Internal Medicine, Nordland Hospital, Bodø, Norway.,Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - H Bjørnstad
- Cardiac Care Unit, Division of Internal Medicine, Nordland Hospital, Bodø, Norway.,Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - T E Mollnes
- Research Laboratory, Nordland Hospital, Bodø and K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway.,Department of Immunology, Oslo University Hospital and K.G. Jebsen IRC, University of Oslo, Oslo, Norway.,Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - A Hovland
- Cardiac Care Unit, Division of Internal Medicine, Nordland Hospital, Bodø, Norway.,Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
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28
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Boehncke WH, Qureshi A, Merola JF, Thaçi D, Krueger GG, Walsh J, Kim N, Gottlieb AB. Diagnosing and treating psoriatic arthritis: an update. Br J Dermatol 2015; 170:772-86. [PMID: 24266754 DOI: 10.1111/bjd.12748] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2013] [Indexed: 12/14/2022]
Abstract
Psoriatic arthritis (PsA) is an inflammatory arthritis of uncertain pathogenesis, affecting approximately one in four patients with psoriasis. Onset of psoriasis typically precedes the development of PsA. Therefore, the dermatologist is ideally positioned to recognize the early signs and symptoms of PsA for diagnosis and subsequent treatment. The role of the dermatologist in early diagnosis and treatment is essential for preventing pain and functional disabilities, as well as the joint deterioration that accompanies progressive forms of PsA. Diagnosis of PsA is a key aspect of the clinical decision process for the dermatologist, as psoriasis plus PsA requires a different therapeutic approach from that required for psoriasis alone. Furthermore, PsA is associated with an increased risk of cardiovascular comorbidities that present significant health concerns. In this review, the pathogenesis and comorbidities of PsA are discussed. In addition, screening and imaging tools that aid in the diagnosis of PsA, as well as tools used for efficacy assessment, are reviewed. Available therapies are presented, with a focus on targeted biologics and emerging treatments.
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Affiliation(s)
- W H Boehncke
- Geneva University Hospital, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
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29
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Bombelli M, Maloberti A, Rossi S, Rea F, Corrao G, Bonicelli Della Vite C, Mancia G, Grassi G. Clinical value of NT-proBNP assay in the emergency department for the diagnosis of heart failure (HF) in very elderly people. Arch Gerontol Geriatr 2015; 61:296-300. [PMID: 25991044 DOI: 10.1016/j.archger.2015.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/30/2015] [Accepted: 05/04/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Scanty data are available on the accuracy of NT-proBNP in the diagnosis of HF and effects of comorbidities in very elderly patients. METHODS Symptoms, signs, NT-proBNP, eGFR, Ht, CRP and the presence of cardiomegaly and pleuric effusion were assessed in 895 consecutive patients aged 86±4.3 years admitted to Emergency Department and used to define the diagnosis of HF according to Framingham criteria. Receiver operating characteristic curves (ROC) were used to calculate diagnostic performance and cutoff of NT-proBNP. Sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) were computed for all NT-proBNP cutoffs. RESULTS Satisfactory diagnostic performance was obtained with a lower threshold of 980pg/mL (Sn 0.95; NPV 0.90) and a higher threshold of 5340 (Sp 0.85; PPV 0.76) but with 42.4% of patients in the uncertainty area. We determined a second couple of cutoffs (1470-4200) that reduced the gray-area to 27.4%, maintaining an acceptable diagnostic performance compared to commonly used cutoffs (300-1800). Ht, CRP and eGFR all correlated with NT-proBNP in groups with and without HF but none affected diagnostic performance. CONCLUSION NT-proBNP performs satisfactorily for the diagnosis of HF in very elderly patients. Proposed threshold couple, compared with the most used cutoffs, showed a gain in Sp and PPV with a slightly lower performance in Sn and NPV and with a decrease in the gray-area with the second one. Our data do not support the use of different NT-proBNP cutoffs depending on eGFR, Ht and CRP.
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Affiliation(s)
| | | | - Stefano Rossi
- Clinica Medica, University of Milano - Bicocca, Monza, Italy
| | - Federico Rea
- Statistical Department, University of Milano - Bicocca, Milan, Italy
| | - Giovanni Corrao
- Statistical Department, University of Milano - Bicocca, Milan, Italy
| | | | - Giuseppe Mancia
- Clinica Medica, University of Milano - Bicocca, Monza, Italy
| | - Guido Grassi
- Clinica Medica, University of Milano - Bicocca, Monza, Italy; IRCCS Multimedica, Sesto San Giovanni, Italy
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30
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Lazzerini PE, Capecchi PL, Acampa M, Galeazzi M, Laghi-Pasini F. Arrhythmic risk in rheumatoid arthritis: the driving role of systemic inflammation. Autoimmun Rev 2014; 13:936-44. [PMID: 24874445 DOI: 10.1016/j.autrev.2014.05.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/20/2014] [Indexed: 01/08/2023]
Abstract
When compared to the general population, patients with rheumatoid arthritis (RA) have an overall standard mortality ratio of approximately two, with more than 50% of premature deaths attributable to cardiovascular disease (CVD). Moreover, RA patients were twice as likely to experience sudden cardiac death (SCD) compared with non-RA subjects, as a putative consequence of an increased incidence of malignant arrhythmias. Accordingly, mounting data indicate that in patients affected with RA the risk of developing rhythm disturbances, particularly tachyarrhythmias, is high. Although a number of papers reviewing the problem of cardiovascular involvement in RA are currently available, the main focus is on the mechanisms of accelerated atherosclerosis and related ischemic consequences in the clinical setting. On the contrary, only little consideration has been specifically given to the arrhythmic risk so far. In the light of this concern, in the present paper we reviewed the topic with the aim to put together the apparently fragmentary existing information, with particular attention to the putative role of chronic systemic inflammation characterizing the disease. In fact, although the underlying mechanisms accounting the arrhythmogenic substrate in RA are probably intricate, the leading role seems to be played by inflammatory activation, able to promote arrhythmias either indirectly, by accelerating the development of structural CVD, and directly by affecting cardiac electrophysiology. In this view, lowering inflammatory burden through an increasingly tight control of disease activity may represent the most effective intervention to reduce arrhythmic risk and prevent life-threatening complications in these patients.
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Affiliation(s)
- Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy.
| | | | | | - Mauro Galeazzi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Franco Laghi-Pasini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
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31
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Mirjafari H, Welsh P, Verstappen SMM, Wilson P, Marshall T, Edlin H, Bunn D, Chipping J, Lunt M, Symmons DPM, Sattar N, Bruce IN. N-terminal pro-brain-type natriuretic peptide (NT-pro-BNP) and mortality risk in early inflammatory polyarthritis: results from the Norfolk Arthritis Registry (NOAR). Ann Rheum Dis 2013; 73:684-90. [PMID: 23511225 PMCID: PMC3963600 DOI: 10.1136/annrheumdis-2012-202848] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background We measured N-terminal pro-brain natriuretic peptide (NT-pro-BNP), a marker of cardiac dysfunction, in an inception cohort with early inflammatory polyarthritis (IP) and assessed its association with disease phenotype, cardiovascular disease (CVD), all-cause and CVD related mortality. Methods Subjects with early IP were recruited to the Norfolk Arthritis Register from January 2000 to December 2008 and followed up to death or until March 2010 including any data from the national death register. The associations of baseline NT-pro-BNP with IP related factors and CVD were assessed by linear regression. Cox proportional hazards models examined the independent association of baseline NT-pro-BNP with all-cause and CVD mortality. Results We studied 960 early IP subjects; 163 (17%) had prior CVD. 373 (39%) patients had a baseline NT-pro-BNP levels ≥100 pg/ml. NT-pro-BNP was associated with age, female gender, HAQ score, CRP, current smoking, history of hypertension, prior CVD and the presence of carotid plaque. 92 (10%) IP subjects died including 31 (3%) from CVD. In an age and gender adjusted analysis, having a raised NT-pro-BNP level (≥100 pg/ml) was associated with both all-cause and CVD mortality (adjusted HR (95% CI) 2.36 (1.42 to 3.94) and 3.40 (1.28 to 9.03), respectively). These findings were robust to adjustment for conventional CVD risk factors and prevalent CVD. Conclusions In early IP patients, elevated NT-pro-BNP is related to HAQ and CRP and predicts all-cause and CVD mortality independently of conventional CVD risk factors. Further study is required to identify whether NT-pro-BNP may be clinically useful in targeting intensive interventions to IP patients at greatest risk of CVD.
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Affiliation(s)
- Hoda Mirjafari
- Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, , Manchester, UK
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32
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Decker E, Müller-Ladner U. [Rheumatoid arthritis. Systemic inflammation and cardiovascular morbidity]. Internist (Berl) 2013; 54:434-40. [PMID: 23463461 DOI: 10.1007/s00108-012-3188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In recent years it could be shown that systemic inflammation, which typically occurs in chronic inflammatory rheumatic diseases, significantly contributes to cardiovascular morbidity and mortality. All rheumatic diseases inherit this enhanced risk for cardiovascular complications with rheumatoid arthritis being one of the most prominent. As the underlying pathophysiological mechanisms are very similar with respect to endothelial damage all rheumatic diseases and specifically rheumatoid arthritis should be monitored and treated with disease-modifying drugs and biological agents as consistently as possible to be able to improve the long-term outcome of affected patients as much as possible.
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Affiliation(s)
- E Decker
- Abteilung für Rheumatologie und klinische Immunologie, Kerckhoff-Klinik GmbH, Benekestr. 2-8, 61231 Bad Nauhei.
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33
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NT-proBNP levels may be influenced by inflammation in active ankylosing spondylitis receiving TNF blockers: a pilot study. Clin Rheumatol 2013; 32:879-83. [DOI: 10.1007/s10067-013-2182-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 01/02/2013] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
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34
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Lin PJ, Tam YYC, Hafez I, Sandhu A, Chen S, Ciufolini MA, Nabi IR, Cullis PR. Influence of cationic lipid composition on uptake and intracellular processing of lipid nanoparticle formulations of siRNA. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2013; 9:233-46. [DOI: 10.1016/j.nano.2012.05.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 05/18/2012] [Accepted: 05/29/2012] [Indexed: 01/12/2023]
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35
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Acute and long-term effect of infliximab on humoral and echocardiographic parameters in patients with chronic inflammatory diseases. Clin Rheumatol 2012; 32:61-6. [DOI: 10.1007/s10067-012-2091-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 08/31/2012] [Accepted: 09/11/2012] [Indexed: 10/27/2022]
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36
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Gruden G, Barutta F, Chaturvedi N, Schalkwijk C, Stehouwer CD, Pinach S, Manzo M, Loiacono M, Tricarico M, Mengozzi G, Witte DR, Fuller JH, Perin PC, Bruno G. NH2-terminal probrain natriuretic peptide is associated with diabetes complications in the EURODIAB Prospective Complications Study: the role of tumor necrosis factor-α. Diabetes Care 2012; 35:1931-6. [PMID: 22699286 PMCID: PMC3425012 DOI: 10.2337/dc12-0089] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Circulating levels of NH(2)-terminal probrain natriuretic peptide (NT-proBNP), a marker of acute heart failure, are associated with increased risk of cardiovascular disease (CVD) in the general population. However, there is little information on the potential role of NT-proBNP as a biomarker of vascular complications in type 1 diabetic patients. We investigated whether serum NT-proBNP levels were associated with micro- and macrovascular disease in type 1 diabetic subjects. RESEARCH DESIGN AND METHODS A cross-sectional nested case-control study from the EURODIAB Prospective Complications Study of 507 type 1 diabetic patients was performed. Case subjects (n = 345) were defined as those with one or more complications of diabetes; control subjects (n = 162) were those with no evidence of any complication. We measured NT-proBNP levels by a two-site sandwich electrochemiluminescence immunoassay and investigated their associations with complications. RESULTS Mean NT-proBNP levels were significantly higher in case than in control subjects. In logistic regression analyses, NT-proBNP values >26.46 pg/mL were independently associated with a 2.56-fold increased risk of all complications. Odds ratios of CVD (3.95 [95% CI 1.26-12.35]), nephropathy (4.38 [1.30-14.76]), and distal symmetrical polyneuropathy (4.32 [1.41-13.23]) were significantly increased in patients with NT-proBNP values in the highest quartile (>84.71 pg/mL), independently of renal function and known risk factors. These associations were no longer significant after inclusion of TNF-α into the model. CONCLUSIONS In this large cohort of type 1 diabetic subjects, we found an association between NT-proBNP and diabetic micro- and macrovascular complications. Our results suggest that the inflammatory cytokine TNF-α may be involved in this association.
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Affiliation(s)
- Gabriella Gruden
- Department of Internal Medicine, University of Turin, Turin, Italy.
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37
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B-type natriuretic peptide in rheumatic diseases: a cardiac biomarker or a sophisticated acute phase reactant? Autoimmun Rev 2012; 11:837-43. [PMID: 22401930 DOI: 10.1016/j.autrev.2012.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 02/20/2012] [Indexed: 01/08/2023]
Abstract
Natriuretic peptides (NP) are secreted by cardiomyocytes and are reliable markers of cardiac dysfunction and cardiovascular risk by reflecting myocardial stress due to various etiologies. Clinical and occult heart involvement is frequently observed in patients with rheumatic diseases and is associated with increased morbidity and mortality. Cardiac disease in autoimmune disorders encompasses different pathophysiological mechanisms including inflammation and involving either the myocardium or the coronary/pulmonary vessels. Although the major trigger for the synthesis and release of NP is myocardial strain, there is also some support for the concept that inflammation stimulates the neurohormonal system of the heart leading to increased production of NP. Recent studies have focused on the association of NP and inflammation in the context of rheumatic diseases, suggesting that up-regulation of neurohormonal axis in these conditions is linked with inflammation. Additionally the NP have a well-documented role in the diagnostic work-up of patients with connective tissue disease who are at increased risk of developing pulmonary hypertension, as the right ventricular overload results in increased NP synthesis and release. However the precise role of NP in the assessment and the management of cardiovascular risk in patients with rheumatic diseases is yet to be established. In the current article we discuss the pathophysiologic mechanisms involved in enhanced NP expression in patients with rheumatic disorders and their potential clinical implication in daily practice.
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38
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Kotyla PJ, Owczarek A, Rakoczy J, Lewicki M, Kucharz EJ, Emery P. Infliximab treatment increases left ventricular ejection fraction in patients with rheumatoid arthritis: assessment of heart function by echocardiography, endothelin 1, interleukin 6, and NT-pro brain natriuretic peptide. J Rheumatol 2012; 39:701-6. [PMID: 22337242 DOI: 10.3899/jrheum.110751] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To study the influence of anti-tumor necrosis factor-α (TNF-α) treatment on echocardiographic measures and concentrations of endothelin 1 (ET-1), interleukin 6 (IL-6), and amino-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in a cohort of 23 female patients with rheumatoid arthritis (RA). METHODS We recruited 23 patients (mean age 51.3 ± 1.55 yrs) with RA resistant to treatment with disease-modifying antirheumatic drugs and average disease duration of 7.1 ± 1.0 years who had been selected to start treatment with the anti-TNF-α antagonist infliximab. Transthoracic echocardiographic examinations were performed before the first infusion and repeated after 1 year of treatment. Data for age, sex, RA disease activity by Disease Activity Score (DAS28) and echocardiographic data, NT-proBNP, IL-6, ET-1, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and other routine laboratory data were collected before treatment and after 1 year. RESULTS Twelve months of treatment with infliximab resulted in reduction of RA activity (i.e., reduction of DAS and acute-phase reactants). There was increased left ventricle ejection fraction, from 58.5% before treatment to 63% after. Treatment with infliximab also resulted in significant reduction of ET-1 (1.26 fmol/ml before treatment vs 0.43 fmol/ml after), IL-6 (58.46 pg/ml vs 3.46 pg/ml), and NT-proBNP (43.06 fmol/ml vs 14.78 fmol/ml). These reductions were observed after just 4 months of treatment and remained significant until the termination of the study. CONCLUSION In patients with RA, treatment with infliximab contributed significantly to increase in left ventricular ejection fraction. Improvement of cardiac function was shown by conventional echocardiography; there was reduction of biochemical markers of heart failure.
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Affiliation(s)
- Przemyslaw J Kotyla
- Department of Internal Medicine and Rheumatology, Medical University of Silesia, ul. Ziolowa 45/47, 40-635 Katowice, Poland.
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Evolutionary medicine and chronic inflammatory state--known and new concepts in pathophysiology. J Mol Med (Berl) 2012; 90:523-34. [PMID: 22271169 PMCID: PMC3354326 DOI: 10.1007/s00109-012-0861-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 01/07/2012] [Accepted: 01/09/2012] [Indexed: 11/22/2022]
Abstract
During the last 10 years, a series of exciting observations has led to a new theory of pathophysiology using insights from evolutionary biology and neuroendocrine immunology to understand the sequelae of chronic inflammatory disease. According to this theory, disease sequelae can be explained based on redirection of energy-rich fuels from storage organs to the activated immune system. These disease sequelae are highly diverse and include the following: sickness behavior, anorexia, malnutrition, muscle wasting–cachexia, cachectic obesity, insulin resistance with hyperinsulinemia, dyslipidemia, increase of adipose tissue near inflamed tissue, alterations of steroid hormone axes, elevated sympathetic tone and local sympathetic nerve fiber loss, decreased parasympathetic tone, hypertension, inflammation-related anemia, and osteopenia. Since these disease sequelae can be found in many animal models of chronic inflammatory diseases with mammals (e.g., monkeys, mice, rats, rabbits, etc.), the evolutionary time line goes back at least 70 million years. While the initial version of this theory could explain prominent sequelae of chronic inflammatory disease, it did not however address two features important in the pathogenesis of immune-mediated diseases: the time point when an acute inflammatory disease becomes chronic, and the appearance of hypertension in chronic inflammation. To address these aspects more specifically, a new version of the theory has been developed. This version defines more precisely the moment of transition from acute inflammatory disease to chronic inflammatory disease as a time in which energy stores become empty (complete energy consumption). Depending on the amount of stored energy, this time point can be calculated to be 19–43 days. Second, the revised theory addresses the mechanisms of essential hypertension since, on the basis of water loss, acute inflammatory diseases can stimulate water retention using a positively selected water retention system (identical to the energy provision system). In chronic smoldering inflammation, however, there is no increased water loss. In contrast, there is increased water generation in inflamed tissue and inflammatory cells, and the activation of the water retention system persists. This combination leads to a net increase of the systemic fluid volume, which is hypothesized to be the basis of essential hypertension (prevalence in adults 22–32%).
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Pham T, Bachelez H, Berthelot JM, Blacher J, Bouhnik Y, Claudepierre P, Constantin A, Fautrel B, Gaudin P, Goëb V, Gossec L, Goupille P, Guillaume-Czitrom S, Hachulla E, Huet I, Jullien D, Launay O, Lemann M, Maillefert JF, Marolleau JP, Martinez V, Masson C, Morel J, Mouthon L, Pol S, Puéchal X, Richette P, Saraux A, Schaeverbeke T, Soubrier M, Sudre A, Tran TA, Viguier M, Vittecoq O, Wendling D, Mariette X, Sibilia J. TNF alpha antagonist therapy and safety monitoring. Joint Bone Spine 2011; 78 Suppl 1:15-185. [PMID: 21703545 DOI: 10.1016/s1297-319x(11)70001-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To develop and/or update fact sheets about TNFα antagonists treatments, in order to assist physicians in the management of patients with inflammatory joint disease. METHODS 1. selection by a committee of rheumatology experts of the main topics of interest for which fact sheets were desirable; 2. identification and review of publications relevant to each topic; 3. development and/or update of fact sheets based on three levels of evidence: evidence-based medicine, official recommendations, and expert opinion. The experts were rheumatologists and invited specialists in other fields, and they had extensive experience with the management of chronic inflammatory diseases, such as rheumatoid. They were members of the CRI (Club Rhumatismes et Inflammation), a section of the Société Francaise de Rhumatologie. Each fact sheet was revised by several experts and the overall process was coordinated by three experts. RESULTS Several topics of major interest were selected: contraindications of TNFα antagonists treatments, the management of adverse effects and concomitant diseases that may develop during these therapies, and the management of everyday situations such as pregnancy, surgery, and immunizations. After a review of the literature and discussions among experts, a consensus was developed about the content of the fact sheets presented here. These fact sheets focus on several points: 1. in RA and SpA, initiation and monitoring of TNFα antagonists treatments, management of patients with specific past histories, and specific clinical situations such as pregnancy; 2. diseases other than RA, such as juvenile idiopathic arthritis; 3. models of letters for informing the rheumatologist and general practitioner; 4. and patient information. CONCLUSION These TNFα antagonists treatments fact sheets built on evidence-based medicine and expert opinion will serve as a practical tool for assisting physicians who manage patients on these therapies. They will be available continuously at www.cri-net.com and updated at appropriate intervals.
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Affiliation(s)
- Thao Pham
- Rheumatology Department, CHU Sainte-Marguerite, Marseille, France.
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Kozera L, Andrews J, Morgan AW. Cardiovascular risk and rheumatoid arthritis--the next step: differentiating true soluble biomarkers of cardiovascular risk from surrogate measures of inflammation. Rheumatology (Oxford) 2011; 50:1944-54. [DOI: 10.1093/rheumatology/ker232] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Silva Fernández L, Barbadillo Mateos C, Fernández Castro M, Otón Sánchez T. Los otros biomarcadores. ¿Qué debe saber el reumatólogo? ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.semreu.2011.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Crowson CS, Myasoedova E, Davis JM, Roger VL, Karon BL, Borgeson D, Rodeheffer RJ, Therneau TM, Gabriel SE. Use of B-type natriuretic peptide as a screening tool for left ventricular diastolic dysfunction in rheumatoid arthritis patients without clinical cardiovascular disease. Arthritis Care Res (Hoboken) 2011; 63:729-34. [PMID: 21225672 PMCID: PMC3091972 DOI: 10.1002/acr.20425] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) are at an increased risk for heart failure and left ventricular diastolic dysfunction (LVDD). B-type natriuretic peptide (BNP) may be useful to screen for LVDD in the general population. We compared the effectiveness of BNP as a screening tool for LVDD in RA and non-RA subjects without cardiovascular disease (CVD). METHODS Study subjects were recruited from population-based samples with and without RA, excluding subjects with CVD. LVDD was assessed by 2-dimensional and Doppler echocardiography and categorized as none, mild, moderate/severe, or indeterminate. Linear regression and proportional odds models evaluated the association between LVDD and BNP, adjusting for age, sex, and body mass index. RESULTS Among 231 RA and 1,730 non-RA subjects without CVD, BNP was significantly higher in subjects with moderate/severe LVDD compared to those with no or mild LVDD (P = 0.02 for RA and P < 0.001 for non-RA subjects). More RA subjects had elevated BNP than non-RA subjects (16% versus 9%; P < 0.001). Positive predictive value (25% in RA and 18% in non-RA subjects) and sensitivity (40% in RA and 26% in non-RA subjects) were similarly low in both cohorts, but specificity was significantly lower in RA than in non-RA subjects (89% versus 94%; P = 0.02). CONCLUSION While RA subjects were more likely to have elevated BNP, few RA patients with elevated BNP actually have LVDD. Also, normal BNP levels are less likely to rule out LVDD in RA than in non-RA subjects. Therefore, BNP may be less effective for screening in RA subjects compared to the general population.
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MESH Headings
- Aged
- Arthritis, Rheumatoid/blood
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/physiopathology
- Biomarkers/blood
- Case-Control Studies
- Diastole
- Echocardiography, Doppler
- Female
- Humans
- Linear Models
- Logistic Models
- Male
- Mass Screening/methods
- Middle Aged
- Minnesota
- Natriuretic Peptide, Brain/blood
- Odds Ratio
- Predictive Value of Tests
- Risk Assessment
- Risk Factors
- Severity of Illness Index
- Up-Regulation
- Ventricular Dysfunction, Left/blood
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
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Affiliation(s)
- Cynthia S. Crowson
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Elena Myasoedova
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - John M. Davis
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Veronique L. Roger
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Division of Cardiovascular Diseases, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Barry L. Karon
- Division of Cardiovascular Diseases, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Daniel Borgeson
- Division of Cardiovascular Diseases, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Richard J. Rodeheffer
- Division of Cardiovascular Diseases, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Terry M. Therneau
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Sherine E. Gabriel
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Amino-terminal pro-brain natriuretic peptide as a prognostic marker in patients with rheumatoid arthritis. Clin Rheumatol 2010; 30:61-9. [PMID: 21110214 DOI: 10.1007/s10067-010-1622-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 11/05/2010] [Indexed: 01/03/2023]
Abstract
Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality, of which amino-terminal pro-brain natriuretic peptide (NT-proBNP) is a predictor. The objective of the study was to investigate associations between NT-proBNP and age, gender, markers of inflammation, disease activity, and kidney function in RA patients, without co-morbidities potentially influencing NT-proBNP concentration. The study group consisted of 90 patients with RA, without clinically relevant coronary heart disease, hypertension, diabetes, advanced chronic kidney disease. The comprehensive assessment of clinical and laboratory parameters of inflammation, disease activity, and kidney function was performed. Plasma samples were frozen for NT-proBNP analysis. Carotid intima media thickness (cIMT) was determined by high-resolution B-mode ultrasonography. The mean NT-proBNP concentrations were significantly higher in a group of RA patients with high disease activity (DAS28 > 5.1) and in a group of patients with subclinical atherosclerosis diagnosed by cIMT ≥ 0.6 mm. In all RA patients, NT-proBNP correlated positively with the age, C-reactive protein, erythrocyte sedimentation rate, cIMT, tricipital skin fold and negatively with hand-grip strength, hemoglobin, red blood cell count, albumin. In the group of women with RA, we found significant positive correlation between NT-proBNP and cystatin-C. Also, patients with NT-proBNP level ≥ 100 pg/ml had significantly higher cystatin-C than those with lower NT-proBNP. NT-proBNP level, in RA patients without co-morbidities potentially influencing this level, is correlated with age, disease activity markers of inflammation, and subclinical renal impairment. It means that risk of CV disorders is higher in older patients with more active RA.
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