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Changes in lipid profile during infliximab and corticosteroid treatment in rheumatoid arthritis
  1. M J L Peters1,
  2. M Vis1,
  3. V P van Halm1,2,
  4. G J Wolbink2,3,
  5. A E Voskuyl1,
  6. W F Lems1,2,4,
  7. B A C Dijkmans1,2,4,
  8. J W R Twisk5,
  9. M H M T de Koning2,
  10. R J van de Stadt2,
  11. M T Nurmohamed6
  1. 1Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
  2. 2Department of Rheumatology, Jan van Breemen Institute, Amsterdam, The Netherlands
  3. 3CLB Sanquin, Amsterdam, The Netherlands
  4. 4Department of Rheumatology, Slotervaart Hospital, Amsterdam, The Netherlands
  5. 5Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
  6. 6Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to:
    Dr M T Nurmohamed
    Departments of Internal Medicine and Rheumatology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands; mt.nurmohamed{at}vumc.nl

Abstract

Objective: To evaluate the effects of infliximab and corticosteroid treatment on the lipid profile in patients with active rheumatoid arthritis (RA).

Methods: Infliximab infusions were given at weeks 0, 2, 6 and then every 8 weeks. Before each infusion, disease activity parameters (Disease Activity Index 28-Joint Score (DAS28)) C reactive protein (CRP) and lipid levels (total cholesterol, high-density lipoprotein (HDL)-cholesterol, triglycerides, apolipoprotein A1 (apo A1) and apolipoprotein B) were measured in 80 consecutive patients with RA, who completed the study period of 48 weeks. Longitudinal analyses were used to investigate (1) the course of lipid levels over a period of time and (2) the relationship between lipids, prednisone dose and disease activity.

Results: Infliximab treatment causes a significant reduction in disease activity and a concomitant decrease in prednisone dose. Although they initially improved significantly, all lipid levels had returned to baseline levels after 48 weeks, except for apo A1. Longitudinal analyses revealed significant yet opposite associations between lipid levels and disease activity and between lipid levels and prednisone dose. DAS28 improvement by 1 point was associated with an increase of 0.016 mmol/l (0.618 mg/dl) total cholesterol and 0.045 mmol/l (1.737 mg/dl) HDL-cholesterol. Reduction of 10 mg prednisone was associated with a decrease of 0.04 mmol/l (1.544 mg/dl) total cholesterol and 0.16 mmol/l (6.177 mg/dl) HDL-cholesterol.

Conclusion: Overall, no changes in serum lipid levels were observed after 48 weeks of infliximab treatment. The initial beneficial effects of infliximab on the lipid profile, by means of a reduction of disease activity, are attenuated by a concomitant decrease in prednisone dose.

  • apo A1, apolipoprotein A1
  • apo B, apolipoprotein B
  • CVD, cardiovascular disease
  • DAS28, Disease Activity Index 28-Joint Score
  • GEEs, general estimation equations
  • HDL, high-density lipoprotein
  • RA, rheumatoid arthritis
  • MTX, methotrexate

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Footnotes

  • Published Online First 21 February 2007

  • Competing interests: None.

  • Ethical approval: The authors explicitly state that the local ethics committee has approved the present study.

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