To evaluate the effect of infliximab and rituximab on cardiovascular risk in patients with rheumatoid arthritis.
Material and methods
We recruited 95 patients (mean age 42,74±7,23 years) with a definite established RA (duration of disease – 6.1±2.9 years; DAS28 – 6.09 ± 1.14) without comorbid pathology. All patients were treated with infliximab (n=32) or rituximab (n=63). At baseline and after 1 year of treatment, the structural and functional parameters of the common carotid arteries and heart were studied using ultrasound method. At 5 years, we studied the occurrence of cardiovascular events in 39 patients who continued treatment with biologic agents.
At baseline, 75 (78.9%) patients presented with diastolic dysfunction of left ventricle. One-year treatment with infliximab or rituximab resulted in improvement of at least one parameter of diastolic function in 10 (31.2%) and 19 (30.2%) patients, respectively. The thickness of the intima media complex of the common carotid artery was initially increased in 75 (78.9%) patients, while the stiffness index was high in 17 (17.9%) patients. Treatment with infliximab was not associated with any changes of these parameters. However, rituximab induced a decrease in the thickness of the intima media complex of the right common carotid artery by 8.9% (p<0.01) and of the left common carotid artery by 16.7% (p<0.01). Stiffness index in the rituximab group has decreased by 6.4% (p<0.05). At 5 years, the incidence of cardiovascular events with infliximab was numerically higher than with rituximab (25% and 13%, respectively).
Therapy with infliximab and particularly rituximab has a positive effect on cardiovascular risk.
Rheumatoid arthritis, infliximab, rituximab, cardiovascular risk.