title: Influence of triple disease modifying anti-rheumatic drug therapy on carotid artery inflammation in drug-naive patients with recent onset of rheumatoid arthritis.
abstract: Increased atherosclerosis in RA is not fully explained by the ordinary risk factors, but it may be related to vascular inflammation. The aim of this study was to investigate the degree of carotid artery inflammation in drug-naive patients with early RA before and after DMARD triple therapy.
  
  
  
  Fifteen non-diabetic patients with recently diagnosed RA [age 51 (16) years, 6 males] were examined before and at 2 and 4 weeks after the initiation of combination therapy with MTX, SSZ, HCQ and ⩽10 mg/day oral prednisolone. Eight healthy males aged 49 (6) years were examined once as controls. Inflammation in the carotid artery was quantified, using [(18)F]fluorodeoxyglucose ((18)F-FDG)-PET/CT, as the maximum standardized uptake value (SUVmax) and the maximum target-to-background ratio (TBRmax).
  
  
  
  Before the treatment, patients with RA had significantly higher carotid artery (18)F-FDG uptake, as compared with healthy controls [TBRmax 1.78 (0.07) vs 1.51 (0.08), P = 0.03]. The 4-week DMARD therapy reduced the TBRmax to the level of healthy controls [1.53 (0.05), P = 0.84]. Compared with the baseline, the TBRmax decreased by 12.4 (16.8)% (P = 0.01) during 4-week DMARD therapy. At baseline, the SUVmax correlated with ESR (r = 0.52, P = 0.02) and CRP (r = 0.65, P = 0.01). Change in SUVmax correlated with changes in ESR and CRP after 4 weeks of treatment, as did the changes in TBRmax and SUVmax with DAS at 12 weeks of treatment.
  
  
  
  (18)F-FDG-PET/CT revealed that drug-naive patients with early RA show carotid artery inflammation that can be efficiently reduced by 1-month DMARD triple therapy.
authors.affiliation: Turku PET Centre, University of Turku Turku PET Centre, Turku University Hospital.
authors.forename: Matti
authors.initials: M
authors.lastname: Haavisto
authors.affiliation: Turku PET Centre, University of Turku Turku PET Centre, Turku University Hospital Heart Center.
authors.forename: Antti
authors.initials: A
authors.lastname: Saraste
authors.affiliation: Department of Internal Medicine.
authors.forename: Laura
authors.initials: L
authors.lastname: Pirilä
authors.affiliation: Turku PET Centre, University of Turku Turku PET Centre, Turku University Hospital.
authors.forename: Jarna C
authors.initials: JC
authors.lastname: Hannukainen
authors.affiliation: Turku PET Centre, University of Turku Turku PET Centre, Turku University Hospital.
authors.forename: Kari K
authors.initials: KK
authors.lastname: Kalliokoski
authors.affiliation: Turku PET Centre, University of Turku.
authors.forename: Anna
authors.initials: A
authors.lastname: Kirjavainen
authors.affiliation: Turku PET Centre, University of Turku Turku PET Centre, Turku University Hospital Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital and University of Turku, Turku, Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Kemppainen
authors.affiliation: Department of Internal Medicine.
authors.forename: Timo
authors.initials: T
authors.lastname: Möttönen
authors.affiliation: Turku PET Centre, University of Turku Turku PET Centre, Turku University Hospital.
authors.forename: Juhani
authors.initials: J
authors.lastname: Knuuti
authors.affiliation: Department of Internal Medicine.
authors.forename: Timo
authors.initials: T
authors.lastname: Yli-Kerttula
authors.affiliation: Turku PET Centre, University of Turku Turku PET Centre, Turku University Hospital anne.roivainen@utu.fi.
authors.forename: Anne
authors.initials: A
authors.lastname: Roivainen
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001167:Arteritis / Q000188:drug therapy*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002340:Carotid Artery Diseases / Q000188:drug therapy*; D017536:Carotid Artery, Common; D016022:Case-Control Studies; D004359:Drug Therapy, Combination; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: DMARD; inflammation; positron emission tomography; rheumatoid arthritis