Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

Anti-Tnf Therapy: Cardiac Safety in Rheumatoid Arthritis and Ankylosing Spondylitis with Subclinical Diastolic Dysfunction

Moraes,  Julio C. B., Lianza,  Alessandro C., Ribeiro,  Ana C. M., Goncalves,  Carla, Carvalho,  Jozelio F., Pereira,  Rosa M. R., Guedes,  Lissiane K. N.


Recent studies have suggested that N-terminal pro-brain natriuretic peptide (NT-proBNP), a sensitive marker used for diagnosis of heart failure (HF), is elevated in rheumatoid arthritis (RA) without an association with clinical cardiac dysfunction. We therefore have prospectively evaluated this biochemical parameter concomitantly with a new highly sensitive non-invasive tissue Doppler imaging (TDI) in RA and Ankylosing Spondylitis (AS) patients pre- and post- anti-TNFa therapy in order to accurately define the presence of subclinical myocardial injury.


Twenty-five patients, 11 RA (ACR criteria) and 14 AS (NY criteria) were prospectively enrolled. Exclusion criteria were history of HF, coronary disease, renal insufficiency and severe hypertension. Patients were evaluated at baseline (BL) and 6 months (6M) after anti-TNFa therapy for demographic, clinical and laboratory data. Myocardial function was determined by NT-proBNP (electrochemiluminescence immunoassay) and echocardiogram [M- mode, TDI and conventional Doppler techniques] using GE Vingmed Vivid-3 Expert.


BL evaluation revealed for RA and AS, respectively: mean age 49.4±11.9 and 35.5±10.6 yrs old; female gender 100 and 28.6%; white race 63.6 and 78.6%; current smoker 27.3 and 16.7%; hypertension 27.3 and 7.1%; body mass index 24±2.9 and 24.3±3,3kg/m2 and prednisone current dose 8±4.6 and 2.7±4.4mg/d. Initial measurements demonstrated diastolic ventricular dysfunction (DVD) in 9/11 (81.8%) RA and 4/14 (28.6%) AS, p=0.015. None of these 9 RA worsened and 3 recovered after 6M with a tendency of improvement in right ventricle lateral wall velocities (LWV) [S wave (p=0.05), A wave (p=0.07)] in the TDI, whereas no change was observed in left ventricle LWV and interventricular septum (p>0.05). All other parameters (fraction of ejection, E mitral wave, A mitral wave, desaceleration time and isovolumetric relaxed time (p>0.05) remained stable. With regard to echocardiographic finding in AS, 2(50%) improved and the other 2 had no change. NT-proBNP, in RA, was initially elevated in 5 (45.6%), all with DVD, contrasting with normal levels in AS. Mean NT-proBNP RA levels reduced significantly at 6M (145±146 vs. 79.±73pg/mL, p=0.046). Disease activity parameters comparing BL and 6M were for RA [DAS 28 (5.7± 0.9 vs. 3.9±1.4, p= 0.0019), CRP (11.1±13.1 vs. 5.5±7.1mg/L, p=0.06) and ESR (29±19.8 vs. 16.6±12.5mm, p=0.06)], and for AS [BASDAI 4.3±2.2 vs. 1.9±2.6 p=0.019), CRP (28.5±28 vs. 5.5±9.2mg/L, p=0.0013) and ESR (24.1±22.3 vs. 5.1±5.6mm, p=0.026].


Our data supports the cardiac safety of anti-TNFa therapy for RA and AS patients in spite of the remarkable high frequency of subclinical diastolic dysfunction in severe RA patients determined by TDI. This finding is further emphasized by the longitudinal reduction of NT-pro-BNP

To cite this abstract, please use the following information:
Moraes, Julio C. B., Lianza, Alessandro C., Ribeiro, Ana C. M., Goncalves, Carla, Carvalho, Jozelio F., Pereira, Rosa M. R., et al; Anti-Tnf Therapy: Cardiac Safety in Rheumatoid Arthritis and Ankylosing Spondylitis with Subclinical Diastolic Dysfunction [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1609
DOI: 10.1002/art.26683

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