Background Cardiovascular (CV) event rates are increased in Rheumatoid Arthritis (RA). Traditional cardiovascular risk factors do not adequately account for the extent of cardiovascular disease in RA1. The relation among biomarkers of endothelial dysfunction, inflammation and vascular function remain uncertain. Hence, we investigated the relationship between biomarkers of endothelial dysfunction, inflammation and vascular function in RA patients.
Objectives To investigate the relationship between biomarkers of endothelial dysfunction, inflammation and vascular function in RA patients.
Methods 30 adult RA patients (4 male, 26 female) and 30 age and sex matched healthy controls (6 male, 24 female) were enrolled in the study. Assessment of FMD done by Angiodefender™ (Everest Genomic, United States). Soluble adhesion molecules (sICAM-1 and sVCAM-1) and pro-inflammatory cytokines (TNF-α, IL-6 and IL-1) was measured using standard ELISA kits. As surrogates for disease activity, DAS28, C-reactive protein and ESR levels were determined.
Results Compared with healthy controls, RA patients had significantly (p<0.05) increased basal concentrations of soluble intracellular adhesion molecules (sICAM-1), soluble vascular cell adhesion molecule (sVCAM-1), tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-1 (IL-1). A significant negative correlation was found between VCAM-1 and FMD (P<0.05) and positive correlation was found between VCAM-1 and TNF-α (P<0.05). while sICAM-1 was positively correlated with IL-1 (P<0.05). A significant positive correlation was found between VCAM-1 and inflammatory measures like DAS28 and CRP in RA patients.
Conclusions In RA, endothelial activation correlates with FMD, through inappropriate secretion of cytokines. Our, study findings support the possibility that systemic inflammation may represent a mechanistic link between adhesion molecules and vascular dysfunction. This suggests that the expression of cell adhesion molecules is up regulated by pro-inflammatory cytokines and association with endothelial dysfunction may have a central role in the mechanism of immune-mediated inflammation and atherosclerosis. This is the first study which shows a relationship between adhesion molecule and vascular function assessed by brachial artery flow mediated vasodilatation. This study opens the possibility of employing therapeutic agents to protect the vessels from the effects of adhesion molecules.
Wolfe F, Freundlich B, Straus WL. Increase in cardiovascular and cerebrovascular disease prevalence in rheumatoid arthritis. J Rheumatol 2003;30:36-40.
Acknowledgements This study was supported by Research Grant from Universal Grant Commission, New Delhi [F. No.41-725/2012 (SR)].
Disclosure of Interest : None declared