title: Effects of adalimumab treatment on vascular disease associated with early rheumatoid arthritis.
abstract: BACKGROUND
  Increased cardiovascular morbidity has become a leading cause of mortality in rheumatoid arthritis (RA). Tumor necrosis factor-alpha (TNFa) inhibitors may influence flow-mediated vasodilation (FMD) of the brachial artery, common carotid intima-media thickness (ccIMT) and arterial stiffness indicated by pulse-wave velocity (PWV) in RA.
  
  
  OBJECTIVE
  To assess the effects of adalimumab treatment on FMD, ccIMT and PWV in early RA.
  
  
  METHODS
  Eight RA patients with a disease duration < or =1 year received 40 mg adalimumab subcutaneously every 2 weeks. Ultrasound was used to assess brachial FMD and ccIMT. PWV was determined by arteriograph. These parameters were correlated with C-reactive protein, vonWillebrand factor (vWF), immunoglobulin M (IgM)-rheumatoid factor (RF), anti-CCP levels and 28-joint disease activity score (DAS28).
  
  
  RESULTS
  Adalimumab therapy successfully ameliorated arthritis as it decreased CRP levels (P = 0.04) and DAS28 (P < 0.0001). Endothelial function (FMD) improved in comparison to baseline (P < 0.05). ccIMT decreased after 24 weeks, indicating a mean 11.9% significant improvement (P = 0.002). Adalimumab relieved arterial stiffness (PWV) after 24 weeks. Although plasma vWF levels decreased only non-significantly after 12 weeks of treatment, an inverse correlation was found between FMD and vWF (R = -0.643, P = 0.007). FMD also inversely correlated with CRP (R = -0.596, P= 0.015). CRP and vWF also correlated with each other (R = 0.598, P = 0.014). PWV and ccIMT showed a positive correlation (R = 0.735, P = 0.038).
  
  
  CONCLUSIONS
  Treatment with adalimumab exerted favorable effects on disease activity and endothelial dysfunction. It also ameliorated carotid atherosclerosis and arterial stiffness in patients with early RA. Early adalimumab therapy may have an important role in the prevention and management of vascular comorbidity in RA.
authors: Cardiovascular Unit, Third Department of Medicine, University of Debrecen Medical and Health Science Center, Debrecen, Hungary.
authors: György
authors: G
authors: Kerekes
authors: Pál
authors: P
authors: Soltész
authors: Gabriella
authors: G
authors: Szucs
authors: Szilvia
authors: S
authors: Szamosi
authors: Henriett
authors: H
authors: Dér
authors: Zoltán
authors: Z
authors: Szabó
authors: László
authors: L
authors: Csáthy
authors: Andrea
authors: A
authors: Váncsa
authors: Peter
authors: P
authors: Szodoray
authors: Gyula
authors: G
authors: Szegedi
authors: Zoltán
authors: Z
authors: Szekanecz