Background Rheumatoid arthritis (RA) is a chronic inflammatory disease that has been associated with an increase of cardiovascular disease (CVD). However, the mechanism underlying the high incidence of CVD is unclear. It has been postulated that the chronic inflammation associated with RA could lead to an accelerated atherogenesis. Lipid peroxidation and low antioxidants levels are associated with increase of CVD and RA. Furthermore, inflammatory markers and cytokines has related with inflammatory responses and pathogenesis in RA and also atherosclerosis.
Objectives To evaluate in RA patients the vitaminic status and their relation with secretory phospholipase A2 (sPLA2) and other inflammatory markers, and also lipid peroxidation parameters.
Methods The study comprises 30 patients with diagnosed RA according ACR 1987 criteria under treatment and 30 matched controls. Inflammatory markers studied were sPLA2, VCAM, ICAM, TNFα, IFNγ, CRP, ESR and fibrinogen. Lipid profile, size distribution of LDL subclasses and the binding affinity of LDL to chondroitin-6-sulfate glycosaminoglycan (GAG) were analysed. The vitamins A and E were determinated in plasma by HPLC. The susceptibility of LDL oxidation was evaluated by the kinetics of conjugated dienes formation induced by hemin. Lag phase (LP), maximal rate of diene production (MR), and maximum diene production (MDP) were studied.
Results RA patients had significant higher plasma levels of sPLA2, VCAM, ICAM, TNFα, IFNγ, CRP, ESR and fibrinogen compared with controls. LDL cholesterol in patients with RA was lower (p < 0.05). Plasma RA patients had significantly higher levels of small dense LDL and lower levels of large light LDL than controls (p < 0.01). LDL affinity (Kd) to GAG were significantly higher in RA patients than in controls (p < 0.05). No differences were observed in vitamins and among the different phases of the dienes formation. In RA patients, a negative correlation between vitamins A and E and sPLA2 (p < 0.01), as well as between vitamins and CRP(p < 0.01), was observed.
A positive correlation between Kd LDL and LP (p < 0.05) in RA patients was observed.
Conclusion These results suggest that inflammation influences the vitaminic status in RA patients. This alteration combined with the presence of atherogenic small LDL with high affinity for GAG may contribute sinergistically to the higher risk for atherosclerotic CVD reported in RA patients.
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