Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Anti-TNF Therapy Reduces Adipocytokine Levels and Improves the Lipid Profile in Patients with Rheumatoid Arthritis: A Possible Mechanism Contributing to Lowered Cardiovascular Risk.

Herenius2,  Marieke, Klaasen2,  Ruth, de Jager4,  Wilco, Prakken4,  Berent, Gerlag3,  Daniëlle, Tak1,  Paul P.

Academic Med Ctr/Univ of Amsterdam, Amsterdam, The Netherlands
Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, The Netherlands
Department of Pediatric Immunology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands

Background:

The atherosclerotic process is accelerated in patients with rheumatoid arthritis (RA), contributing to higher mortality rates than those found in the general population. Recently, treatment with TNF-blockers has been associated with a lower risk of first-ever CVD events. However the mechanisms by which TNF-blockers exert this effect is unclear. Adipocytokines have been linked to obesity, insulin resistance, inflammation, and coronary heart disease in the general population and their serum levels are elevated in RA. To explore the relationship between inflammation and atherogenesis, we investigated the effects of anti-TNF therapy on serum adipocytokine levels (adiponectin, resistin, leptin and visfatin) and known risk factors such as C-reactive protein levels and lipid profile in RA patients.

Methods:

49 patients with active disease (disease activity score evaluated in 28 joints (DAS28)) >=3.2) were started on adalimumab therapy (40 mg subcutaneously every other week). Blood was drawn from patients while fasting at baseline and 16 weeks after the initiation of therapy. Lipid profiles (total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides (TG), lipoprotein (a) (Lp(a)), ApoA- I and Apo B levels), CRP and ESR were determined. Adiponectin, resistin and leptin levels were measured using multiplex analysis and visfatin levels were measured by ELISA.

Results:

After 16 weeks of treatment, there was a significant reduction in DAS28 (p<0.001), ESR (p<0.001), and CRP (p<0.001) levels. Of interest, we found a decrease in serum concentrations of resistin (19,2%, p=0.02) and visfatin (17.2%, p=0.09). There were not clear cut changes in serum levels of adiponectin (p= 0.91) and leptin (p=0.55). Furthermore, a significant improvement was seen of the TC/HDL ratio (p=0.047), the apoB/apo A-I ratio (p=0.013) and lp(a) levels (p<0.001). Baseline visfatin levels correlated with BMI, TC/HDL ratio and LDL/HDL ratio. In addition, the decrease in visfatin levels was related to improvements in LDL/HDL ratio (r=0.32, p=0.05) and TC/HDL ratio (r=0.35, p=0.03)

Conclusions:

These data support the downregulation of visfatin as a potential new mechanism by which anti-TNF therapy might reduce vascular inflammation, and as such cardiovascular morbidity in RA patients. These data are in line with recent observations that elevated visfatin levels are related to abnormalities in lipid metabolism.

To cite this abstract, please use the following information:
Herenius, Marieke, Klaasen, Ruth, de Jager, Wilco, Prakken, Berent, Gerlag, Daniëlle, Tak, Paul P.; Anti-TNF Therapy Reduces Adipocytokine Levels and Improves the Lipid Profile in Patients with Rheumatoid Arthritis: A Possible Mechanism Contributing to Lowered Cardiovascular Risk. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :719
DOI: 10.1002/art.28487

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