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Open Access Highly Accessed Research article

Anti-TNFα therapy transiently improves high density lipoprotein cholesterol levels and microvascular endothelial function in patients with rheumatoid arthritis: a Pilot Study

Aamer Sandoo12*, Jet J C S Veldhuijzen van Zanten12, Tracey E Toms1, Douglas Carroll2 and George D Kitas123

Author Affiliations

1 Department of Rheumatology, Dudley Group of Hospitals NHS Foundation Trust, Russells Hall Hospital, Pensnett Road, Dudley, West Midlands, DY1 2HQ, United Kingdom

2 School of Sport and Exercise Sciences, University of Birmingham, Birmingham, UK

3 Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK

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BMC Musculoskeletal Disorders 2012, 13:127  doi:10.1186/1471-2474-13-127

Published: 23 July 2012

Abstract

Background

Rheumatoid arthritis (RA) is associated with increased morbidity and mortality from cardiovascular disease (CVD). This can be only partially attributed to traditional CVD risk factors such as dyslipidaemia and their downstream effects on endothelial function. The most common lipid abnormality in RA is reduced levels of high-density lipoprotein (HDL) cholesterol, probably due to active inflammation. In this longitudinal study we hypothesised that anti-tumor necrosis factor-α (anti-TNFα) therapy in patients with active RA improves HDL cholesterol, microvascular and macrovascular endothelial function.

Methods

Twenty-three RA patients starting on anti-TNFα treatment were assessed for HDL cholesterol level, and endothelial-dependent and -independent function of microvessels and macrovessels at baseline, 2-weeks and 3 months of treatment.

Results

Disease activity (CRP, fibrinogen, DAS28) significantly decreased during the follow-up period. There was an increase in HDL cholesterol levels at 2 weeks (p < 0.05) which was paralleled by a significant increase in microvascular endothelial-dependent function (p < 0.05). However, both parameters returned towards baseline at 12 weeks.

Conclusion

Anti-TNFα therapy in RA patients appears to be accompanied by transient but significant improvements in HDL cholesterol levels, which coexists with an improvement in microvascular endothelial-dependent function.

Keywords:
Dyslipidaemia; Anti-TNFα; Endothelial function; Rheumatoid arthritis; Cardiovascular disease