Background Intact glycocalyx is of importance for healthy endothelial function. Changes in the endothelial glycocalyx, characterized by increased levels of circulating syndecan-1, might be related to accelerated atherosclerosis in RA.
Objectives To examine the effect of anti-rheumatic treatment on serum syndecan-1 levels.
Methods From the Norwegian observational PSARA study, we selected 32 patients starting with methotrexate (MTX) and/or anti-tumor necrosis factor (anti-TNF) treatment due to active RA. S-syndecan-1 was measured by ELISA at baseline and after 6 weeks of the treatment.
Results The mean age of the patients was 59±8 years, and 27% were men. 12 patients received MTX and 20 received MTX and anti-TNF. S-syndecan-1 significantly decreased during the treatment (49±52 ng/ml vs. 45±50 ng/ml, p=0.047). The difference was independent of age, sex and DAS28. The s-syndecan-1 reduction was greater in the MTX than MTX+anti-TNF group (10±13 vs. 1±1 ng/ml, p=0.048).
Conclusions Anti-rheumatic treatment reduces s-syndecan-1 in RA. Thus, a glycocalyx ameliorating effect may contribute to the reduction of cardiovascular morbidity due to anti-rheumatic treatment. In theory, the greater reduction of s-syndecan-1 in the MTX than in the combined group might be due to differences in patient population (less severe RA and a shorter disease duration in patients treated with MTX compared to anti-TNF). Interestingly, although MTX is considered a less potent anti-rheumatic drug than anti-TNF, it may have an important cardioprotective effect caused by its protective effect on glycocalyx etc. This effect might be at least partially independent of its anti-inflammatory properties.
Disclosure of Interest None declared