Durable blockade of TNF-α in patients with rheumatoid arthritis (RA) suppresses disease activity and its progression. Cardiovascular diseases are 1.5 to 2 fold more frequent in RA patients than in general population. Although TNF-α has well-established effects on lipid metabolism, long-term effects of TNF-α blockade on lipid pattern are still unclear. In the present study we investigated the effects of one-year therapy with anti-TNF on the lipid profile of RA patients.
Methods: Disease activity (DAS28) and plasma lipoproteins concentrations (total, HDL and LDL-cholesterol, triglycerides, ApoA, ApoB) were assessed in 55 RA patients and 55 controls. The whole RA group was followed-up for 6 months and 31 of the patients for 1 year.
Results: In RA patients, DAS28 decreased after 2 weeks from the start of therapy (p<0.001) and remained low during the entire study duration. Short-term effects of anti-TNF on plasma lipid concentrations seemed beneficial and anti-atherogenic. However, these changes did not persist: plasma concentrations of total and LDL-cholesterol and the atherogenic index increased after 6 months and one year from the start of therapy. During therapy, the changes in disease activity and inflammatory status inversely correlated with changes in plasma total and HDL cholesterol levels, and positively correlated with the variation of atherogenic index.
Conclusion: We conclude that one-year therapy with infliximab is likely to lead to a more pro-atherogenic pattern of the plasma lipids concentrations. However, the overall impact of these changes on the cardiovascular risk is more complex, considering the strong anti-inflammatory effects of anti-TNF drugs.
- cardiovascular risk
- rheumatoid arthritis
- tumor necrosis factor