Comparative effects of infliximab and rituximab on preclinical structural and functional changes of cardiovascular system in rheumatoid arthritis


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.

Key words

Rheumatoid arthritis, infliximab, rituximab, cardiovascular risk.