title: Infliximab is associated with improvement in arterial stiffness in patients with early rheumatoid arthritis -- a randomized trial.
abstract: OBJECTIVE
  To determine the efficacy of methotrexate (MTX) with infliximab (IFX) compared with MTX alone in the prevention of atherosclerosis and arterial stiffness in patients with early rheumatoid arthritis (RA).
  
  
  METHODS
  A randomized, open-label study in which early RA patients with active disease were treated with MTX alone (n = 20) and MTX plus IFX (n = 20) for 6 months. Patients were assessed every 3 months. Patients from the MTX-alone group who failed to achieve 28-joint Disease Activity Score remission (DAS28 ≤ 2.6) at 6 months were permitted to escape to open-label IFX. Intima-media thickness (IMT), pulse wave velocity (PWV), and augmentation index (AIx) were measured at baseline, 6 months, and 12 months.
  
  
  RESULTS
  At 6 months, there was a significantly greater reduction in PWV in the MTX-alone group (0.18 ± 1.59 m/s) compared with the MTX plus IFX group (-0.78 ± 1.13 m/s; p = 0.044), accompanied by significantly greater reduction in patient's global assessment, number of swollen joints, C-reactive protein, and DAS28 in the MTX plus IFX group compared to the MTX-alone group. The changes in IMT and AIx were similar between the 2 groups. At 12 months, there was a trend favoring early combination treatment with regard to the reduction in PWV (p = 0.06).
  
  
  CONCLUSIONS
  MTX plus IFX causes a more significant reduction in PWV than MTX alone in patients with early RA after 6-month treatment, and further improvement may be achieved in patients who continued on longterm tumor necrosis factor-α blockers, suggesting that early, effective suppression of inflammation may prevent progression of atherosclerosis by improving vascular function.
authors.affiliation: Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. tamls_813@yahoo.com
authors.forename: Lai-Shan
authors.initials: LS
authors.lastname: Tam
authors.forename: Qing
authors.initials: Q
authors.lastname: Shang
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Li
authors.forename: Shang
authors.initials: S
authors.lastname: Wang
authors.forename: Rui-Jie
authors.initials: RJ
authors.lastname: Li
authors.forename: Ka-Lai
authors.initials: KL
authors.lastname: Lee
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Leung
authors.forename: King-Yee
authors.initials: KY
authors.lastname: Ying
authors.forename: Cheuk-Wan
authors.initials: CW
authors.lastname: Yim
authors.forename: Emily W
authors.initials: EW
authors.lastname: Kun
authors.forename: Moon-Ho
authors.initials: MH
authors.lastname: Leung
authors.forename: Martin
authors.initials: M
authors.lastname: Li
authors.forename: Tena K
authors.initials: TK
authors.lastname: Li
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Zhu
authors.forename: Ricky K
authors.initials: RK
authors.lastname: Chui
authors.forename: Lorraine
authors.initials: L
authors.lastname: Tseung
authors.forename: Shui-Lian
authors.initials: SL
authors.lastname: Yu
authors.forename: Woon-Pang
authors.initials: WP
authors.lastname: Kuan
authors.forename: Cheuk-Man
authors.initials: CM
authors.lastname: Yu
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D050197:Atherosclerosis / Q000175:diagnosis / Q000517:prevention & control*; D001783:Blood Flow Velocity / Q000187:drug effects; D059168:Carotid Intima-Media Thickness; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005260:Female; D006304:Health Status; D006801:Humans; D000069285:Infliximab; D007596:Joints / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D063177:Pulse Wave Analysis; D012720:Severity of Illness Index; D017211:Treatment Failure; D059289:Vascular Stiffness / Q000187:drug effects* / Q000502:physiology
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab; D008727:Methotrexate