Response to anti-tumour necrosis factor alpha blockade is associated with reduction of carotid intima-media thickness in patients with active rheumatoid arthritis.

Objectives. To determine whether tumour necrosis factor (TNF)-α blockers may reduce carotid intima-media thickness (cIMT) in patients with active rheumatoid arthritis (RA) steadily responsive to such therapy. Methods. From 287 consecutive RA patients attending our out-patient clinic and diagnosed on the basis of the American College of Rheumatology (ACR) criteria, 49 without traditional cardiovascular risk factors and meeting the requirements for TNF-α blockers therapy were selected. Among them, 39 actually started TNF-α blockers, but only 30, who reached at least a response on the ACR 20% improvement criteria at 14 weeks, maintained during the whole year of treatment, were finally considered (group A). The remaining 10/49, homogeneous for age, sex, traditional cardiovascular risk factors, socioeconomic status, disease activity and duration, who did not consent to TNF-α-blocker administration, were used as controls (group B). Disease activity score in 44 joints (DAS44), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were evaluated before starting the study, and 3, 6, 12 months thereafter; cIMT was measured by ultrasound before and 12 months thereafter only. Results. Patients in group A showed a very significant cIMT reduction (P P 44, ESR and CRP. Moreover, a significant correlation was found between cIMT and DAS44 (r = 0.435, P Conclusions. These results demonstrate that TNF-α blockade is associated with cIMT reduction in RA patients steadily responsive to therapy, probably by lowering inflammation. [ABSTRACT FROM AUTHOR]