Contributed equally. Suad Hannawi: ten. Copyright © Hannawi et al.
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Abstract Introduction Patients with recent-onset rheumatoid arthritis RA have impaired brachial artery endothelial function compared with controls matched for age, sex and cardiovascular risk factors. The present study examined endothelium-dependent flow-mediated dilatation FMD and independent glyceryl trinitrate Brachialis arthritisz -mediated dilatation GMD structural responses in early RA patients, and determined progress over one year. Methods Brachial artery FMD and GMD and carotid intima media thickness cIMT were studied using ultrasound in 20 patients diagnosed with early RA in brachialis arthritisz symptoms had been present for less than 12 months, and in 20 control subjects matched for age, sex and established cardiovascular risk factors.
Data were analysed by univariate regression. Conclusions Patients with recent-onset RA have altered brachial artery responses signifying both functional and structural abnormalities.
However, early control of inflammation may reduce arterial dysfunction and thus the tendency for atherosclerotic progression.
Introduction Patients with rheumatoid arthritis RA experience cardiovascular CV events more often than expected [ 1 ] and their mortality attributable to CV causes is increased [ 2 ]. Furthermore, ischaemic heart disease IHD has been found to occur about 10 years earlier in patients with RA compared with a population of patients with osteoarthritis matched for classical CV risk factors.
Although atherosclerosis can manifest as overt CV disease, it can be detected at an earlier stage by recognition of abnormal endothelial function and elevated carotid intima media thickness cIMT as measured by ultrasound. These measures correlate closely with direct measurement of local and systemic atherosclerotic burden in studies of pathology and with clinical CV endpoints [ 56 ].
Ultrasonographic assessment of the common carotid artery brachialis arthritisz a feasible, reliable, valid and cost-effective method for both population studies and clinical trials of atherosclerosis brachialis arthritisz and regression [ 7 ]. We showed that cIMT is significantly higher in patients presenting with early RA than in controls matched for age, sex and CV risk factors [ 8 ].
Endothelial function can be assessed by ultrasound as flow-mediated vasodilatation of the brachial artery in response to increased vessel wall shear stress and mediated by nitric oxide NO release by endothelial cells [ 910 ]. Brachial artery vasodilatation can also be assessed by exogenous NO after sublingual brachialis arthritisz trinitrate GTN [ 11 ]. Post-GTN vasodilatation is considered endothelium-independent and predominantly mediated by smooth muscle.
The dose-response curve for GTN-mediated vasodilatation has been examined in subjects with proven coronary artery disease and in healthy controls [ 12 ]. Patients with coronary disease had significantly reduced GTN-mediated vasodilatation, with the greatest difference observed with lower doses of GTN, suggesting that izomfájdalom gyógyszer is associated with functional abnormalities of both endothelium and vascular smooth muscle cells [ 12 ].
A previous study of 10 patients with early RA demonstrated impaired flow-mediated endothelial function, with improvement over six months of therapy [ 13 ]. Moreover, infliximab therapy improved endothelial-dependent vasodilatation, apparently through direct endothelial, rather than systemic effects [ 14 ].
In women without RA, treatment-associated improvement in endothelium-dependent vasodilatation has been shown to decrease the risk of subsequent CV events [ 15 ]. Other acute and chronic inflammatory states have also been shown to impair endothelial function [ 20 - 22 ]. In the current study, we studied a group of early RA patients, in whom cIMT had also been determined, and brachialis arthritisz the progression of endothelium-dependent and -independent brachial arterial function after one year.
Search Menu Sir, In rheumatoid arthritis, involvement of the tendons and bursae in the shoulder region is a common finding. Subacromial bursitis is usually secondary to impingement and presents with pain around the shoulder.
Given the relationship of inflammation severity to atherosclerotic burden, as measured by cIMT and carotid plaque, at presentation with early RA [ 23 ], we hypothesised that inflammatory indices would predict arterial responses. Therefore, a group brachialis arthritisz conventional CV risk factors and indices of RA inflammatory disease were analysed at baseline and brachialis arthritisz year to determine their relationship to changes in brachial artery response.
A brachialis idegek tünetei és kezelése
Materials and methods RA patients All 31 study participants met the American College of Rheumatology revised criteria for the classification of RA [ 24 ].
All the patients were enrolled from to with a diagnosis of RA with symptom duration less than 12 months. Patients attended an early RA clinic regularly, and received combination methotrexate MTXsulfasalazine SSZ and hydroxychloroquine HCQ [ 25 ], unless contraindicated, after diagnosis and active disease were confirmed.
After diagnosis, patients were treated according to a response-driven step-up algorithm, as previously described [ 26 ], with the aim of achieving clinical remission [ 27 - 29 ]. Intra-articular but not oral corticosteroids were used to control inflammation in addition to disease-modifying antirheumatic drugs DMARDsas required.
An additional 20 healthy subjects were recruited from the community, who could be matched for age, sex and CV risk factors against 20 of the early RA subjects. We matched against a database of more than individuals recruited in a primary prevention setting.
The primary match was with the age and gender, after which we matched on number and type of risk factors on a categorical basis. Although exact blood pressure or lipid levels were not matched, we were able to match for hypertension and hyperlipidaemia, in addition to smoking status in almost all the cases.
Study procedure The study was approved by the human research ethics committee at Princess Alexandra Hospital, Woolloongabba, and all subjects provided written informed consent. CV risk brachialis arthritisz were ascertained among RA patients at baseline, as previously described [ 8 ]. RA disease activity parameters and laboratory measurements were assessed as previously described, at baseline and 12 months.
Individual blood pressure and heart rate remained constant during the testing. No subject had ultrasound evidence of brachial artery atherosclerotic plaque. Ultrasonography was performed csípőízületek betegségei a trained investigator SH who was unaware of the subject's clinical data, using a high-resolution ultrasound machine, according to the International Brachial Artery Reactivity Task force Guidelines [ 30 ].
Two patients brachialis arthritisz taking statins, one was taking an angiotensin-converting enzyme inhibitor and one patient was taking both.
Although all four patients were taking a once daily dose of their medication, they were asked to postpone this medication until after the vascular ultrasound. No patient was taking aspirin or GTN treatment. Subjects rested in a supine position in a quiet, dark, temperature-controlled room.
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A pneumatic cuff was placed around the upper forearm distal to the segment of brachial artery, scanned in longitudinal section 2 to 10 cm above the antecubital crease. A baseline scan was recorded for two minutes, followed by induction of hyperaemia by cuff inflation to mmHg for four minutes.
The FMD scan commenced 30 seconds before release of the cuff, and continued for one brachialis arthritisz afterwards. A second baseline scan was recorded 10 minutes later. The coefficient of variation cv was 0. A tablet of GTN was administered sublingually in a standardised manner and recording was continued for a further four minutes for GMD. The cv was 0.
Measurement of the brachial artery diameter was synchronised with the R wave of the electrocardiogram, to avoid possible errors resulting from artery pulsation. FMD and GMD were expressed as the relative increase in brachial artery diameter during hyperaemia: cIMT was measured using carotid duplex scanning and automated software as previously described [ 31 ].
The cv for cIMT was 0. Statistical analysis In a preliminary evaluation, continuous variables were tested for normality of distribution; transformations were applied for non-normally distributed variables.
Variables with normal distribution were expressed as the mean ± standard deviation SD and categorical variables as percentages.
Log transformations were applied to non-normally distributed data. Brachial reactivity improvement, inflammatory and RA disease activity markers and lipid profile were summarised using mean values for the baseline measures and compared with the mean values at one year using paired Student's t-tests.
The differences between the mean values were examined by two-sample Student's t-tests. Four patients had previous CV events, including one male with a previous transient ischaemic attack at 52 years of age, two males with a history of angina at the ages of 48 and 64 years, and one patient with myocardial infarction MI at age 48 years.
Brachialis arthritisz of these RA patients could be matched for age, sex and CV risk factors against 20 healthy control subjects from a database of more than individuals recruited in a primary prevention setting. Table 1 Patient details at baseline and one year Week 0.