The effect of tumor necrosis factor-α antagonists on arterial stiffness in rheumatoid arthritis: a literature review.

Abstract

BACKGROUND:

There is evidence that patients with rheumatoid arthritis (RA) have a higher arterial stiffness than their age-matched healthy counterparts and thus have a higher cardiovascular risk. Under National Institute for Clinical Excellence guidelines, tumor necrosis factor-α (TNF-α) antagonists are indicated clinically in patients with severe active rheumatoid disease. TNF-α antagonists have been found to reduce inflammatory markers in RA; however, it is debatable if they have favorable effects on the cardiovascular system. This review evaluates the effect of TNF-α antagonists on arterial stiffness, a predictor of cardiovascular disease, in RA patients.

SEARCH STRATEGY:

A search of Ovid MEDLINE and ISI Web of Knowledge databases was conducted to identify studies into the effect of TNF-α antagonists on arterial stiffness in RA patients. Eight studies matching the search criteria were included for analysis.

FINDINGS:

Two methods were used to assess arterial stiffness: pulse wave velocity and augmentation index. Despite inconsistencies in augmentation index values, aortic pulse wave velocity in all but one study was significantly reduced following TNF-α antagonist treatment. Most studies had methodological limitations, including inadequate sample size, nonblinding of those involved in the measurements, and inadequate inclusion/exclusion criteria. Variation in results could be due to the use of different TNF-α antagonists, different outcome measures being used, and differences in follow-up.

CONCLUSIONS:

The balance of evidence suggests that TNF-α antagonists may have a beneficial effect on arterial stiffness and therefore cardiovascular risk. However, larger more robust longer term studies are warranted to confirm recent findings.

• Authors: Rajdip Dulai, Mark Perry, Richard Twycross-Lewis, Dylan Morrissey, Fabiola Atzeni, Stephen Greenwald
• Journal: Seminars in arthritis and rheumatism (Semin Arthritis Rheum) Vol. 42 Issue 1 Pg. 1-8 (Aug 2012) ISSN: 1532-866X [Electronic] United States
• PMID: 22475245 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents
• Immunoglobulin G
• Receptors, Tumor Necrosis Factor
• Tumor Necrosis Factor-alpha
• Infliximab
• Adalimumab
• Etanercept

Topics

• Adalimumab
• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Antirheumatic Agents (therapeutic use)
• Arteriosclerosis (complications, drug therapy, physiopathology)
• Arthritis, Rheumatoid (complications, drug therapy, physiopathology)
• Databases, Bibliographic
• Endothelium, Vascular (drug effects)
• Etanercept
• Humans
• Immunoglobulin G (therapeutic use)
• Infliximab
• Pulse Wave Analysis
• Receptors, Tumor Necrosis Factor (therapeutic use)
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)
• Vascular Resistance (drug effects)
• Vascular Stiffness (drug effects, physiology)
• Vasodilation (drug effects)