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The effect of anti-tumor necrosis factor (TNF)-alpha therapy with etanercept on endothelial functions in patients with rheumatoid arthritis tedavisinin endotel fonksiyonları üzerine etkisi [Anatol J Cardiol]
Anatol J Cardiol. 2010; 10(2): 98-103 | DOI: 10.5152/akd.2010.031

The effect of anti-tumor necrosis factor (TNF)-alpha therapy with etanercept on endothelial functions in patients with rheumatoid arthritis tedavisinin endotel fonksiyonları üzerine etkisi

Hakan Tıkız1, Özlem Arslan2, Timur Pırıldar3, Canan Tıkız4, Petek Bayındır5
1Department of Cardiology Faculty of Medicine, University of Celal Bayar, Manisa
2Department of Cardiology, Özel Doğuş Hospital, Mersin
3Department of Rheumatology Faculty of Medicine, University of Celal Bayar, Manisa
4Department of Physical Medicine of Medicine, University of Celal Bayar, Manisa
5Department of Radiology, Faculty of Medicine, University of Ege, İzmir

Objective: To investigate the effects of tumor necrosis factor (TNF)-α antagonism with etanercept (ENC) on endothelial functions in patients with active rheumatoid arthritis (RA). Methods: A total of 21 patients with RA were enrolled in this prospective study. Eleven of them (8 women, 3 men mean age 47.0±10.1 years) with high disease activity despite the conventional treatment were assigned to Group 1 and were given ENC treatment twice a week (25 mg SC injection) for 12 weeks. Ten patients with RA (8 women, 2 men mean age 55.0±6.4 years) under conventional methotrexate and prednisone therapy were assigned as Control group (Group 2). Endothelium-dependent and -independent vasodilator responses of the brachial artery were assessed by high-resolution ultrasound. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also measured at baseline and at the post treatment period. Mann-Whitney U and Wilcoxon tests were used to compare the data and correlation analysis was performed using Pearson correlation test. Results: Endothelium-dependent vasodilatation improved from 5.2±0.8% to 7.9±1.3% (p=0.04) in ENC group, while no significant change was observed in the control group (from 6.6±1.1% to 7.0±1.8% p=0.67). No significant changes were found in endothelium-independent vasodilatation and baseline brachial artery diameters in both groups. A significant reduction in ESR and CRP were observed in patients receiving ENC (from 16.2±6.8 to 9.2± 5.1 mm/h, p=0.003 and from 14.68±3.4 to 9.25± 3.7 mg/L, p=0.003, respectively). Conclusion: Treatment with ENC for 12 weeks significantly improved endothelial function in patients with active RA compared to those under conventional therapy. The findings of the present study support the hypothesis that the use of TNF-α blockers in patients with active RA may reduce the high incidence of cardiovascular complications.

Keywords: Endothelial function, tumor necrosis factor-alpha, etanercept, rheumatoid arthritis

Hakan Tıkız, Özlem Arslan, Timur Pırıldar, Canan Tıkız, Petek Bayındır. The effect of anti-tumor necrosis factor (TNF)-alpha therapy with etanercept on endothelial functions in patients with rheumatoid arthritis tedavisinin endotel fonksiyonları üzerine etkisi. Anatol J Cardiol. 2010; 10(2): 98-103