title: Inflammatory and prothrombotic biomarkers in patients with rheumatoid arthritis: effects of tumor necrosis factor-alpha blockade.
abstract: OBJECTIVE
  Increased cardiovascular (CV) risk is a rheumatoid arthritis (RA) hallmark and it has been mainly related to chronic systemic inflammation. Since inflammation is linked to coagulation perturbation, both may play a role in increasing CV risk. Treatment with tumor necrosis factor (TNF)-alpha blocking agents is effective in RA and reduces local and systemic inflammation but there is little information on its effect on coagulation. We therefore investigated inflammation and coagulation plasma biomarkers before and after infliximab treatment in RA patients.
  
  
  METHODS
  We studied 20 patients with active RA and 40 healthy controls. Patients were treated with: a stable dose of methotrexate (10mg/week), and infliximab (3mg/kg) at weeks 0, 2, 6 and 14. At baseline and week 14, we determined: disease activity score (DAS-28), visual analogue scale pain, erythrocyte sedimentation rate (ESR), and plasma levels of C-reactive protein (CRP), TNF-alpha, interleukin (IL)-6, prothrombin fragment 1+2 (F1+2) and D-dimer. The same inflammation and coagulation parameters were evaluated 1h after infliximab infusion in 10 patients.
  
  
  RESULTS
  At baseline, ESR, CRP, TNF-alpha, IL-6, F1+2 and D-dimer levels were significantly higher in RA patients than in controls (P=0.0001). After 14weeks of infliximab treatment, there was a significant clinical improvement and ESR and CRP, IL-6, F1+2 and D-dimer level decrease (P=0.001-P=0.008). The levels of TNF-alpha, IL-6, F1+2 and D-dimer significantly decreased 1h after infliximab infusion (P=0.005).
  
  
  CONCLUSIONS
  Infliximab decreases inflammation and coagulation biomarkers in RA patients. Such a combined effect may be pivotal in reducing the whole thrombotic risk in these patients.
authors: Department of Rheumatology, University of Milan, Istituto Gaetano Pini, Milan, Italy.
authors: Francesca
authors: F
authors: Ingegnoli
authors: Flavio
authors: F
authors: Fantini
authors: Ennio Giulio
authors: EG
authors: Favalli
authors: Amedeo
authors: A
authors: Soldi
authors: Samantha
authors: S
authors: Griffini
authors: Valentina
authors: V
authors: Galbiati
authors: Pier Luigi
authors: PL
authors: Meroni
authors: Massimo
authors: M
authors: Cugno
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000494:pharmacology*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D000069285:Infliximab; D015850:Interleukin-6 / Q000097:blood; D007558:Italy; D008297:Male; D008875:Middle Aged; D013917:Thrombin / Q000187:drug effects; D013927:Thrombosis / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000097:blood*; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D015415:Biomarkers; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D000069285:Infliximab; D013917:Thrombin