Endothelial Dysfunction and Extra-Articular Neurological Manifestations in Rheumatoid Arthritis (original) (raw)
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Endothelial Function in Rheumatoid Arthritis
QJM : monthly journal of the Association of Physicians, 2018
Rheumatoid arthritis (RA) patients are at higher risk of accelerated atherosclerosis. We sought to assess endothelial dysfunction in RA to find a possible mechanistic pathway that will explain this clinical phenomenon. A prospective study recruited 44 RA patients with an active long standing (>12 months) disease. All underwent a detailed assessment of disease activity. To estimate the endothelial function the Brachial Artery Method was performed, measuring flow mediated diameter percent change (FMD%). Clustering analyses (hierarchical and k-means) were performed. Patients were compared to healthy subjects. 44 RA patients (54.42±11.14 years, females (72.7%)) with co-morbidities (70.5%), not taking TNF-blockers or DMARDs (63.6%). Only 6 (13.6%) had a normal endothelial function. Hierarchical and k-means clustering techniques showed statistically significant differences among the three clusters concerning DAS-28-ESR (p = 0.000), DAS-28-CRP (p = 0.001), CDAI (p = 0.002), SDAI (p = 0....
Inflammatory suppression rapidly attenuates microvascular dysfunction in rheumatoid arthritis
Atherosclerosis, 2007
Rheumatoid arthritis (RA) is associated with greater risk of cardiovascular morbidity and mortality, the inflammatory component of RA being strongly linked to this excess risk. Endothelial dysfunction is linked to atherosclerosis and has been demonstrated in larger vessels in RA. In this pilot study, we determined for the first time whether skin microvascular function was impaired in patients with active RA and also determined its response to anti-inflammatory treatment. This was assessed non-invasively using laser Doppler imaging combined with iontophoresis of the vasodilators acetylcholine (ACh, endothelium dependent) and sodium nitroprusside (SNP, endothelium independent) to the forearm. Eight RA patients admitted for acute flare-ups were assessed before and following anti-inflammatory treatment. Standard laboratory indices were obtained along with pain perception (VAS). A control group of eight subjects was included for baseline comparison. Compared to this group, vascular function was substantially and significantly (P < 0.00001) lower in RA patients. Following treatment, as CRP and VAS decreased, vascular function improved for both ACh (P < 0.00001) and SNP (P = 0.001), this improvement being significantly greater for ACh (P < 0.001).
Rheumatoid Arthritis (RA), is a inflammatory joint disease of chronic nature with predominant articular symptoms of pain ,swelling and stiffness.The most common extraarticular manifestation is cardiovascular disease which accounts for 50 % mortality in RA patients . Complex interplay between traditional CVD risk factors ,systemic inflammation and vascular function in RA are the reasons behind the scene worse outcome in RA patients .5 The MCC of mortality in Rheumatoid Arthritis patients is cardiovascular disease .1,2 Endothelial dysfunction is directly related to RA associated systemic inflammation The aim of the review is to discuss Endothelium ,its morphology and normal physiology ,consider endothelial dysfunction (ED ) in RA patients and relate endothelial dysfunction to systemic inflammation and traditional CVD risk factors and also consider the effect of drugs on vascular function.
Mediators of inflammation, 2018
To define the prevalence and determinants of peripheral microvascular endothelial dysfunction (ED) in a large series of rheumatoid arthritis (RA) patients free of previous cardiovascular events. Data from 874 RA patients enrolled in the EDRA study (Endothelial Dysfunction Evaluation for Coronary Heart Disease Risk Estimation in Rheumatoid Arthritis-ClinicalTrials.gov: NCT02341066) were analyzed. Log-transformed reactive hyperemia index (Ln-RHI) was evaluated by peripheral arterial tonometry (PAT) using the EndoPAT2000 device: values of Ln-RHI < 0.51 were considered indicative of peripheral ED. Peripheral microvascular ED was documented in one-third of RA patients (33.5%); in multiple logistic regression analysis, ACPA negativity and higher triglycerides concentrations were independently associated with the presence of peripheral ED [OR (95% CI) = 1.708 (1.218-2.396),< 0.01 and OR (95% CI) = 1.005 (1.002-1.009),< 0.01, respectively]. Multiple regression analysis showed a pos...
The Egyptian Journal of Radiology and Nuclear Medicine, 2013
Aim of the work: The present study aimed at evaluating the prevalence of subclinical atherosclerosis and cardiovascular disease by means of assessment of carotid intima media thickness and endothelium dependent function through assessment of brachial artery flow mediated dilatation in patients with rheumatoid arthritis. Materials and methods: Twenty six patients with rheumatoid arthritis and 20 healthy control subjects underwent measurement of brachial artery FMD and CIMT using B-mode gray scale US for evaluating cardiovascular risk. Results: The brachial artery FMD was -96.6-6.6% in rheumatoid arthritis (indicating ED), and 20-25% in the control group. The CIMT was 0.50-0.72 mm in rheumatoid arthritis and 0.35-0.47 mm in the control group. Conclusion: The results from the present study support the use of carotid US and endothelial function assessment by means of FMD as a useful tool to predict the increased risk of cardiovascular Abbreviations: RA, rheumatoid arthritis; CVD, cardiovascular disease; FMD, flow mediated dilatation; NO, nitric oxide; CIMT, carotid intima media thickness; ED, endothelial dysfunction. disease in patients with rheumatoid arthritis. We suggest that the carotid artery US should be performed for all patients with rheumatoid arthritis to establish the risk of cardiovascular complication which requires more aggressive therapy.
Endothelial dysfunction in inflammatory rheumatic diseases
Romanian journal of internal medicine = Revue roumaine de médecine interne, 2009
The importance of cardiovascular disease in inflammatory rheumatic diseases was recognized as one of the determinants of increased mortality in these patients. An increased cardiovascular disease was reported in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), but also in other rheumatic diseases. Several hypotheses were elaborated, but the chronic inflammatory status seems to be a primordial factor. Therefore, the diagnostic and treatment of cardiovascular disease, even in subclinical status, should be one of most important goals in the global management of these patients. The endothelial dysfunction is now regarded as an important and early step in the processes that promote atherosclerosis. In patients with inflammatory rheumatic diseases, the presence of the endothelial dysfunction was reported and linked with several clinical or biological features of each disease. Moreover, the potential benefits on the endothelial dysfunction of several therapie...
Endothelial dysfunction in young patients with rheumatoid arthritis and low disease activity
Annals of the Rheumatic Diseases, 2004
Background: Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease. Endothelial dysfunction represents the earliest stage of atherosclerosis. Objective: To evaluate the influence of chronic inflammatory state on endothelial function in patients with RA by measuring endothelial reactivity in young patients with RA with low disease activity and without traditional cardiovascular risk factors. Methods: Brachial flow mediated vasodilatation (FMV), assessed by non-invasive ultrasound, was evaluated in 32 young to middle aged patients with RA (age (59 years), with DAS28 (3.2 and without overt cardiovascular disease, and in 28 age and sex matched controls. Results: Mean (SD) FMV was significantly lower in patients than in controls (3.2 (1.3)% v 5.7 (2.0)%; p,0.001), inversely related to low density lipoprotein cholesterol (r = 20.45, p,0.05) and C reactive protein (CRP), expressed as the value at the moment of ultrasound evaluation (r = 20.44, p,0.05), as the average of CRP levels evaluated at different times during the disease (r = 20.47, p,0.05), or as the average of >4 determinations multiplied by the disease duration (r = 20.40, p,0.05). In a multivariate regression model, a lower brachial flow mediated vasodilatation was independently predicted by low density lipoprotein cholesterol (b = 20.40, p,0.05), average CRP levels multiplied by the disease duration (b = 20.44, p,0.05), and brachial artery diameter (b = 20.28, p,0.05). Conclusions: Young to middle aged patients with RA with low disease activity, free from cardiovascular risk factors and overt cardiovascular disease, have an altered endothelial reactivity that seems to be primarily related to the disease associated chronic inflammatory condition.
PubMed, 2008
Objective: Cardiovascular disease is a leading cause of mortality in rheumatoid arthritis (RA). Endothelial dysfunction often precedes manifest atherosclerosis. We assessed endothelial dysfunction and atherosclerosis in RA in context with laboratory markers. Methods: Fifty-two patients with RA and 40 matched healthy controls were studied. We assessed common carotid intima-media thickness (ccIMT) and flow- (FMD) and nitroglycerine-mediated vasodilation (NMD). We also assayed numerous immunological and metabolic laboratory markers. Results: FMD was significantly lower in RA (5.32% +/- 4.66%) compared to controls (8.30% +/- 3.96%) (p = 0.001). NMD was preserved in RA. ccIMT was significantly greater in patients with RA (0.63 +/- 0.14 mm) versus controls (0.54 +/- 0.15 mm) (p = 0.012). In patients with RA, ccIMT correlated with FMD% (R = -0.318, p = 0.022), age (R = 0.831, p < 0.001), and anti-dsDNA levels (R = 0.463, p = 0.006). FMD% correlated with serum interferon-gamma (IFN-gamma) levels (R = 0.516, p = 0.014). NMD% correlated inversely with the percentage of Th0 lymphocytes (R = -0.636, p = 0.006), serum immune complex (R = -0.692, p < 0.001), and IgM levels (R = -0.606, p = 0.003). Patients with RA were divided as "low" (< 0.65 mm) versus "high" (> 0.65 mm) ccIMT groups, and into "normal" (> 5%) versus "impaired" (< 5%) FMD% subsets. Low and high ccIMT groups differed significantly in age and serum interleukin 1 (IL-1) and anti-dsDNA levels. RA patients with normal versus impaired FMD% differed significantly in age, disease duration, and serum IFN-gamma levels. Lipoprotein(a) [Lp(a)] also correlated with rheumatoid factor (RF) and C-reactive protein (CRP); homocysteine (HCy) correlated with CRP and correlated inversely with folate and vitamin B12 production. Paraoxonase-1 (PON-1) activity correlated with serum tumor necrosis factor-alpha(TNF-alpha) and IL-6 levels. Conclusion: This was a well characterized RA population, where FMD and ccIMT were impaired, indicating early endothelial dysfunction and accelerated atherosclerosis, respectively. RA-related autoimmune-inflammatory mechanisms and metabolic factors including anti-CCP, RF, CRP, circulating immune complexes, IgM, TNF-alpha, IL-6, Th0/Th1 ratio, HCy, folate, vitamin B12, and PON-1 may all be involved in the development of vascular disease in RA. Although ccIMT and FMD, as well as some laboratory factors, have been assessed by other investigators in RA-associated atherosclerosis, our results regarding the possible involvement of anti-CCP, anti-dsDNA, Lp(a), some cytokines, and PON-1 activity are novel. Early determination of FMD% and ccIMT may be useful to assess RA patients with high cardiovascular risk.