Tumour necrosis factor inhibitors reduce aortic stiffness progression in patients with long-standing rheumatoid arthritis

Investigating the Association of Aortic Stiffness and Phase Angle with the Clinical Course of Rheumatoid Arthritis

Background

Aortic stiffness is an independent predictor of cardiovascular events which is increased in rheumatoid arthritis (RA). It can be measured by carotid-femoral pulse wave velocity (cfPWV). Phase angle (PhA) is lower in patients with cardiovascular disease and may be informative in assessing the clinical course of RA.

Materials and Methods

In this observational and cross-sectional study, all RA patients referred to the Imam Khomeini Hospital rheumatology clinic between September 2022 and March 2023 were included in the study. RA activity was assessed using the DAS28 criteria. In the patients, PhA and cfPWV were measured using Inbody-s10 and PulsePen tonometer instruments. The relationships between PhA, cfPWV, clinical course of RA, and CRP were evaluated using regression analysis.

Results

53 patients were included in the study (83% female, mean age 46.5 years). Significant inverse relationships existed between PhA, CRP, and age (P value = 0.003, 0.0001, R: 0.69, respectively). People with aortic stiffness had a lower mean PhA (P value = 0.05). In patients with RA duration of less than 10 years, the cfPWV percentile and the prevalence of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) positive cases were higher than in patients with RA duration >10 years (P values = 0.02, 0.01, respectively).

Conclusions

With increasing duration of RA, aortic stiffness and positive serology cases decreased. PhA and cfPWV may be useful in assessing the clinical course of RA to prevent cardiovascular events.

Arterial Stiffness as a Surrogate Marker of Cardiovascular Disease and Atherosclerosis in Patients with Arthritides and Connective Tissue Diseases: A Literature Review

The increased cardiovascular (CV) risk among patients with autoimmune rheumatic diseases, such as arthritides and connective tissue diseases, has been extensively documented. From a pathophysiological standpoint, systemic inflammation in the context of the disease can lead to endothelial dysfunction, accelerated atherosclerosis, and structural changes in vessel walls, which, in turn, are associated with exaggerated CV morbidity and mortality. In addition to these abnormalities, the increased prevalence of traditional CV risk factors, such as obesity, dyslipidemia, arterial hypertension, and impaired glucose metabolism, can further worsen the status of and overall prognosis for CV in rheumatic patients. However, data on appropriate CV screening methods for patients with systemic autoimmune diseases are scarce, and traditional algorithms may lead to an underestimation of the true CV risk. The reason for this is that these calculations were developed for the general population and thus do not take into account the effect of the inflammatory burden, as well as other chronic-disease-associated CV risk factors. In recent years, different research groups, including ours, have examined the value of different CV surrogate markers, including carotid sonography, carotid-femoral pulse wave velocity, and flow-mediated arterial dilation, in the assessment of CV risk in healthy and rheumatic populations. In particular, arterial stiffness has been thoroughly examined in a number of studies, showing high diagnostic and predictive value for the occurrence of CV events. To this end, the present narrative review showcases a series of studies examining aortic and peripheral arterial stiffness as surrogates of all-cause CV disease and atherosclerosis in patients with rheumatoid and psoriatic arthritis, as well as in systemic lupus erythematosus and systemic sclerosis. Moreover, we discuss the associations of arterial stiffness with clinical, laboratory, and disease-specific parameters.

Mendelian randomization study on the causal effects of tumor necrosis factor inhibition on coronary artery disease and ischemic stroke among the general population

Background

Tumor necrosis factor (TNF) is a potent inflammatory cytokine that has been causally associated with coronary artery disease (CAD) and ischemic stroke (IS), implying opportunities for disease prevention by anti-TNF therapeutics.

Methods

Leveraging summary statistics of several genome-wide association studies (GWAS), we assessed the repurposing potential of TNF inhibitors for CAD and IS using drug-target Mendelian randomization (MR) design. Pharmacologic blockade of the pro-inflammatory TNF signalling mediated by TNF receptor 1 (TNFR1) was instrumented by four validated variants. Causal effects of TNF/TNFR1 blockade on CAD (N_case/control upto 122,733/424,528) and IS (N_case/control upto 60,341/454,450) were then estimated via various MR estimators using circulating C-reactive protein (CRP; N_GWAS=204,402) as downstream biomarker to reflect treatment effect. Associations of a functional variant, rs1800693, with CRP, CAD and IS were also examined.

Findings

No protective effect of TNF/TNFR1 inhibition on CAD or IS was observed. For every 10% decrease of circulating CRP achieved by TNF/TNFR1 blockade, odds ratio was 0.98 (95% confidence interval [CI]: 0.60-1.60) for CAD and 0.77 (95% CI: 0.36-1.63) for IS. Findings remained null in all supplement analyses.

Interpretation

Our findings do not support TNFR1 as a promising target for CAD or IS prevention among the general population. Future research is warranted to investigate whether the detrimental effect of circulating TNF on CAD and IS might be counteracted by modulating other relevant drug targets.

Funding

No.

Phytoconstituents from Adenanthera pavonina L. as antioxidants and inhibitors of inducible TNF-α production in BV2 cells

Adenanthera pavonina L. has been used traditionally to relieve inflammation. This study aimed to expand the phytochemical knowledge of A. pavonina and evaluate its constituents for their antioxidant and anti-inflammatory potentials as tumor necrosis factor alpha (TNF-α) inhibitors. The antioxidant activity was evaluated using the DPPH radical scavenging assay, and the inhibition of TNF-α was assessed through ELISA and qRT-PCR techniques. Interestingly, five previously undescribed metabolites, including a pentadienoic acid derivative, a triterpenoid glycoside, and three tamarixetin glycosides, were identified alongside seven known compounds. Most compounds evaluated had higher DPPH radical scavenging capabilities than the standard, trolox. Tamarixetin 3-O-(α-ʟ-rhamnopyranosyl)-(1→2)-β-ᴅ-galactopyranoside (11), a previously undescribed compound, was the most effective at suppressing TNF-α protein and m-RNA levels. Other flavonoid glycosides, quercetin 3-O-(α-ʟ-rhamnopyranosyl-(1→2)-β-ᴅ-xylopyranoside (4), isovitixin (5), and quercetin-3-O-[α-ʟ-rhamnopyranosyl-(1→2)]-[α-ʟ-rhamnopyranosyl-(1→6)]-β-ᴅ-galactopyranoside (9), also significantly lowered TNF-α production.

Rheumatoide Arthritis: TNF-Inhibitoren wirken Aortensteifigkeit entgegen

In Folge der dauerhaften Entzündungsaktivität beschleunigt die rheumatoide Arthritis (RA) die Gefäßalterung, welche sich beispielsweise anhand der Aortensteifigkeit abbilden lässt, und mit einem erhöhten kardiovaskulären Risiko einhergeht. Inwiefern beeinflussen konventionelle synthetische DMARDs (disease-modifying anti-rheumatic drugs) mit oder ohne zusätzliche TNF (Tumornekrosefaktor)-Inhibitoren die Progression der Aortensteifigkeit?