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Influence of anti-tumour necrosis factor therapy on cardiovascular risk factors in patients with active rheumatoid arthritis
  1. C Popa1,2,
  2. M G Netea2,
  3. T Radstake1,
  4. J W M Van der Meer2,
  5. A F H Stalenhoef2,
  6. P L C M van Riel1,
  7. P Barerra1
  1. 1Department of Rheumatology, University Medical Centre St Radboud, Nijmegen, The Netherlands
  2. 2Department of Internal Medicine, University Medical Centre St Radboud, Nijmegen, The Netherlands
  1. Correspondence to:
    Dr P Barrera
    Rheumatology Department, UMC St Radboud, Geert Grooteplein 8, PO Box 9101 6500 HB Nijmegen, The Netherlands;


Background: Tumour necrosis factor (TNF) is known to increase the concentrations of interleukin (IL) 6 and C reactive protein (CRP) and to induce proatherogenic changes in the lipid profile and may increase the cardiovascular risk of patients with rheumatoid arthritis (RA) and other inflammatory disorders.

Objective: To assess whether anti-TNF therapy modifies the cardiovascular risk profile in patients with RA.

Methods: The lipoprotein spectrum and the inflammation markers CRP and IL6 were investigated in 33 patients with RA treated with human anti-TNF monoclonal antibodies (D2E7, adalimumab, Humira) and 13 patients with RA given placebo, before and after 2 weeks’ treatment.

Results: In the anti-TNF treated group, the mean (SD) concentrations of HDL-cholesterol were significantly higher after 2 weeks’ treatment (0.86 (0.30) mmol/l v 0.98 (0.33) mmol/l, p<0.01), whereas LDL and triglyceride levels were not significantly changed. Additionally, a significant decrease in CRP (86.1 (54.4) mg/l v 35.4 (35.0) mg/l, p<0.0001), and IL6 (88.3 (60.5) pg/ml v 42.3 (40.7) pg/ml, p<0.001) concentrations was seen in this group. No changes in lipid profile, IL6, or CRP levels were seen in the placebo group.

Conclusions: TNF neutralisation with monoclonal anti-TNF antibodies increased HDL-cholesterol levels and decreased CRP and IL6 levels after 2 weeks. Therefore this treatment may improve the cardiovascular risk profile of patients with RA.

  • CRP, C reactive protein
  • DAS, Disease Activity Score
  • HDL, high density lipoprotein
  • IL, interleukin
  • LDL, low density lipoprotein
  • RA, rheumatoid arthritis
  • TG, triglyceride
  • TNFα, tumour necrosis factor α
  • anti-tumour necrosis factor α
  • lipoproteins
  • rheumatoid arthritis
  • risk factors

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