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Modulation of lipoprotein plasma concentrations during long-term anti-TNF therapy in patients with active rheumatoid arthritis
  1. Calin Popa1,
  2. Frank H J van den Hoogen2,3,
  3. Timothy R D J Radstake2,
  4. Mihai G Netea1,4,
  5. Agnes E Eijsbouts3,
  6. Martin den Heijer5,6,
  7. Jos W M van der Meer1,4,
  8. Piet L C M van Riel2,
  9. Anton F H Stalenhoef1,
  10. Pilar Barrera2
  1. 1
    Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  2. 2
    Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  3. 3
    Department of Rheumatology, Sint Maartenskliniek Nijmegen, The Netherlands
  4. 4
    Nijmegen University Centre for Infectious Diseases (NUCI), Nijmegen, The Netherlands
  5. 5
    Department of Endocrinology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  6. 6
    Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  1. Calin Popa, MD, Department of Rheumatology (470) and General Internal Medicine (463) Geert Grooteplein 8, 6525 GA, Nijmegen, The Netherlands; c.popa{at}


Objective: Durable blockade of tumour necrosis factor-alpha (TNF-α) in patients with rheumatoid arthritis (RA) suppresses disease activity and its progression. Cardiovascular diseases are 1.5–2-fold more frequent in RA patients than in the general population. Although TNF-α has well-established effects on lipid metabolism, the long-term effects of TNF-α blockade on lipid pattern are still unclear. In the present study, we investigated the effects of 1-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 were followed up 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 1 year from the start of therapy. During therapy, the changes in disease activity and inflammatory status were 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.

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  • Competing interests: None declared.

  • Abbreviations:
    atherogenic index
    disease activity score
    rheumatoid arthritis
    total cholesterol
    tumour necrosis factor