The L-arginine/asymmetric dimethylarginine ratio is improved by anti-tumor necrosis factor-α therapy in inflammatory arthropathies. Associations with aortic stiffness.

Abstract

BACKGROUND:

Anti-Tumor Necrosis Factor (TNF)-α therapy improves vascular pathology in inflammatory arthropathies such as rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. The l-arginine/ADMA ratio is important for modulation of the nitric oxide synthase activity. We examined the effect of TNF-α antagonists on ADMA and l-arginine/ADMA, and associations between ADMA, L-arginine/ADMA, aortic stiffness and carotid intima media thickness (CIMT) in patients with inflammatory arthropathies.

METHODS:

Forty-eight patients who started with anti-TNF-α therapy were compared with a non-treated group of 32 patients. Plasma ADMA and L-arginine were assessed at baseline, 3 and 12 months. In a subgroup of 55 patients, aortic pulse wave velocity (aPWV) was measured at baseline, 3 and 12 moths, and CIMT was examined at baseline and 12 months.

RESULTS:

Anti-TNF-α therapy increased the L-arginine/ADMA ratio (mean [SD]) in the treatment group compared to the control group after 3 months (12 [29] vs. -13 [20], P < 0.001) and 12 months (7 [27] vs. -8 [19], P = 0.008), but did not affect ADMA (3 months: 0.00 [0.09] μmol/L vs. 0.02 [0.07] μmol/L, P = 0.42, 12 months: 0.01 [0.08] μmol/L vs. 0.01 [0.09] μmol/L, P = 0.88). Baseline aPWV was associated with ADMA (P = 0.02) and L-arginine/ADMA (P = 0.02) in multiple regression analyses, and the L-arginine/ADMA ratio was continuously associated with aPWV after initiation of anti-TNF-α therapy (P = 0.03). ADMA and L-arginine/ADMA were not correlated with CIMT.

CONCLUSION:

Anti-TNF-α therapy improved the L-arginine/ADMA ratio in patients with inflammatory arthropathies. ADMA and the L-arginine/ADMA ratio were associated with aPWV, and might have a mechanistic role in the aortic stiffening observed in these patients.

• Authors: Kristin Angel, Sella Aarrestad Provan, Petter Mowinckel, Ingebjørg Seljeflot, Tore Kristian Kvien, Dan Atar
• Journal: Atherosclerosis (Atherosclerosis) Vol. 225 Issue 1 Pg. 160-5 (Nov 2012) ISSN: 1879-1484 [Electronic] Ireland
• PMID: 23014354 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Antirheumatic Agents
• Tumor Necrosis Factor-alpha
• N,N-dimethylarginine
• Arginine

Topics

• Adult
• Antirheumatic Agents (therapeutic use)
• Aorta (physiology)
• Arginine (analogs & derivatives, blood)
• Arthritis, Psoriatic (drug therapy)
• Arthritis, Rheumatoid (drug therapy)
• Blood Pressure
• Carotid Intima-Media Thickness
• Female
• Humans
• Male
• Middle Aged
• Pulse Wave Analysis
• Spondylitis, Ankylosing (drug therapy)
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)
• Vascular Stiffness