Background/Purpose:

The proximal aorta accounts for most of the global arterial stiffening and subsequent complications. Aortic stiffness can be demonstrated by changes in aortic dimensions such as strain (proportional change of aortic area to the minimum area) and, when combined with pressure, distensibility (relative dimensional change related to changes in local pressure). We report aortic size and stiffness changes over 6 months after treatment with infliximab or synthetic DMARDs in a group of RA patients.

Methods:

The study comprised thirty-eight female patients with RA and 30 otherwise healthy female individuals. Those with stable co-morbidities were allowed, but not with a documented cardiovascular disease.  According to the clinical decision of attending physicians (blinded to study protocol), 20 patients received infliximab, while 18 patients received single or combined synthetic DMARDs during the study period. 

At baseline and six months later (prior to first and last infusions), all subjects underwent, complete 2-dimensional transthoracic echocardiography, and systolic and diastolic ascending aortic diameters (SD and DD) were recorded in M-mode 3 cm above the aortic valve from a parasternal long-axis view. Aortic elastic properties were calculated using aortic data and forearm blood pressure values. 

Results:

Regarding baseline demographic features and comorbid conditions, all patients and healthy controls, were comparable.  Baseline treatment profiles and disease activity scores were also similar between two RA groups. Echocardiographic parameters were normal in all subjects, none having significant valvular heart disease, segmental wall motion abnormalities or myocardial hypertrophy.

All groups had similar aortic diameters, but RA groups had significantly reduced aortic strain and distensibility, compared with healthy controls. In both treatment arms, a significant and comparable DAS28 response was achieved at six months.

At the end of study, infliximab-treated group showed significant improvement in either aortic strain (4,3±3,2 vs. 9,2±5,7, %, p<0,01) or aortic distensibility (0,18±0,14 vs. 0,44±0,28, cm²/dynes/103, p<0,01), whereas synthetic DMARD-treated group did not show a significant change.  Correlation analysis revealed that, this achievement, significantly associated with changes in DAS28 and hs-CRP values. 

Conclusion:

RA patients have impaired aortic elasticity, which could be improved with infliximab, but not with synthetic DMARDs, over six months.

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« Back to ACR/ARHP Annual Meeting 2013

ACR Meeting Abstracts - https://acrabstracts.org/abstract/alteration-of-aortic-distensibility-within-6-months-of-treatment-in-ra-patients-an-observational-comparison-of-infliximab-and-synthetic-dmards/