Effects of rosuvastatin on subclinical atherosclerosis and arterial stiffness in rheumatoid arthritis: a randomized controlled pilot trial

Objective.To compare the respective effects of tocilizumab (TCZ) monotherapy, etanercept (ETN) monotherapy, and adalimumab (ADA) monotherapy on arterial stiffness in patients with rheumatoid arthritis (RA) in an open-label, randomized controlled trial.Methods.Patients with RA were eligible if they had active disease (28-joint Disease Activity Score > 3.2) and no prior treatment with methotrexate or biologics. All 64 patients had no history of cardiovascular disease or steroid treatment. Patients were randomly assigned to receive TCZ alone (n = 22), ETN alone (n = 21), or ADA alone (n = 21). Arterial stiffness was assessed with cardio-ankle vascular index (CAVI) and aortic augmentation index normalized to a fixed heart rate of 75 bpm (AIx@75) at baseline and 24 weeks’ followup. Clinical data were collected at regular visits.Results.The characteristics of each group at baseline were not significantly different. In all groups there was significant attenuation from baseline to 24 weeks in CAVI (Week 0-Week 24, TCZ: 0.85 ± 0.15 m/s, p = 0.02; ETN: 0.81 ± 0.18 m/s, p = 0.03; ADA: 0.90 ± 0.21 m/s, p = 0.02) and in AIx@75. There were no significant differences among the groups in measures of CAVI or AIx@75. The 3 therapies made no difference to carotid intima-media thickness and carotid artery plaque. Only TCZ increased fasting serum total cholesterol from baseline to 24 weeks.Conclusion.The 3 types of monotherapy limited arterial stiffness in patients with RA to a similar extent.

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Predictors of Cardiovascular Affection in Patients with Active Rheumatoid Arthritis: Secondary Analysis of a Randomized Controlled Trial

Current Rheumatology Reviews ◽

10.2174/1573397116666201113090145 ◽

2020 ◽

Vol 16 ◽

Author(s):

Eman M. Ibrahem ◽

Salwa S. El-gendi ◽

Amal A. Mahmoud ◽

Sherif M. Abdel-Aal ◽

Fatma H. El Nouby ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Randomized Controlled Trial ◽

Matrix Metalloproteinase ◽

Disease Activity ◽

Controlled Trial ◽

Subclinical Atherosclerosis ◽

Secondary Analysis ◽

Intima Media Thickness ◽

Das28 Score ◽

Randomized Controlled

Objective: This is a secondary analysis of a randomized controlled trial that aimed to assess subclinical atherosclerosis in patients with rheumatoid arthritis (RA) by measuring carotid artery intima-media thickness (CIMT) and correlating it with disease activity and inflammatory markers (including levels of matrix metalloproteinase-3(MMP-3) and matrix metalloproteinase-9 (MMP-9)) and to detect the effectiveness of agents that inhibit matrix metalloproteinases (MMPs) as doxycycline in RA therapy. Methods: One hundred and sixty RA patients were assigned in a randomized clinical trial (clinicaltrial.gov NCT03194204). Disease activity score 28(DAS28), laboratory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), MMP-3, and MMP-9 were done and mean CIMT was measured. Subjects were allocated randomly into one of two treatment arms either methotrexate (MTX) only or MTX with doxycycline 200mg per day orally. Follow up ESR, CRP, DAS28, MMP-3, and MMP-9 levels were re-evaluated after 3 months. Results: There were positive significant correlations between CIMT and disease duration (r = 0.461, p = 0.001), age (r=0.459, p= 0.001), DAS28 score (r= 0.547, p = 0.001), ESR (r =0.413, p = 0.001), CRP (r= 0.281, p = 0.001), MMP-3(r = 0.476, p =0.001), and MMP-9 (r= 0.593, p =0.001). Patients treated with MTX and doxycycline showed lower levels of DAS28, ESR, CRP, MMP-3 and MMP-9 and this was statistically significant. Conclusion: CIMT seems to be the ultimate method to screen for subclinical atherosclerosis in RA patients. MMP-3 and 9 play a key role in both RA synovitis and cardiovascular changes making them important therapeutic targets especially with safe and cost-effective agents like doxycycline.

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