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Infliximab leads to a rapid but transient improvement in endothelial function in patients with primary systemic vasculitis
  1. K Raza1,2,
  2. D M Carruthers2,
  3. R Stevens1,
  4. A D Filer1,
  5. J N Townend3,
  6. P A Bacon1
  1. 1Rheumatology Research Group, Division of Immunity and Infection, The Medical School, The University of Birmingham, Birmingham B15 2TT, UK
  2. 2Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham B18 7QH, UK
  3. 3Department of Cardiology, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, University Hospital Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
  1. Correspondence to:
    Professor P A Bacon


Objective: To assess the immediate effects of tumour necrosis factor α (TNFα) blockade on endothelial function in systemic vasculitis.

Methods: Endothelial function was assessed by laser Doppler flowmetry in patients with active vasculitis after 10 infusions of infliximab. For comparison endothelial responses were assessed after five infusions of cyclophosphamide plus methylprednisolone.

Results: Endothelial dependent vasodilatation (EDV) improved significantly within 24 hours of infliximab infusion. The median change in red blood cell flux (interquartile range) was 5.7 (4.3–8.2) before infusion v 8.4 (7.5–10.9) at 24 hours; p = 0.027. This was not maintained at day 14. No improvement was seen in EDV after cyclophosphamide plus methylprednisolone infusion.

Conclusion: The rapid but transient improvement in EDV after TNFα inhibition suggests that TNFα may have a direct role in the impairment of endothelial function.

  • ACh, acetylcholine
  • BVAS, Birmingham Vasculitis Activity Score
  • EDV, endothelial dependent vasodilatation
  • EIV, endothelial independent vasodilatation
  • IQR, interquartile range
  • LDF, laser Doppler flowmetry
  • NO, nitric oxide
  • PSV, primary systemic vasculitis
  • RA, rheumatoid arthritis
  • RBC, red blood cell
  • SNP, sodium nitroprusside
  • TNFα, tumour necrosis factor α
  • vasculitis
  • endothelial function
  • endothelial dependent vasodilatation
  • tumour necrosis factor α
  • anti-tumour necrosis factor α treatment

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