Sandoo, Aamer (2010)
Ph.D. thesis, University of Birmingham.
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of the joints with predominant symptoms of pain, swelling and stiffness. Patients with RA are at increased risk of cardiovascular disease (CVD). The exact mechanism for this is unknown, but RA disease-related inflammation has been postulated to affect the vasculature and contribute to endothelial dysfunction. The studies presented in this thesis examine vascular function in patients with RA and explore associations with disease-related inflammation as well as CVD risk factors. A cross-sectional study was carried out with 99 RA patients and 32 healthy control participants who underwent assessments of microvascular endothelial function, macrovascular endothelial function and arterial stiffness (AIx). Microvascular and macrovascular endothelial function were similar in RA patients and healthy control participants, but AIx was higher in the RA patients, as was global CVD risk. RA disease-related inflammation was not associated with microvascular or macrovascular endothelial-dependent function, however, global CVD risk inversely correlated with microvascular endothelial-dependent function and macrovascular endothelial-independent function. A longitudinal study was conducted in 23 RA patients starting on anti-tumor necrosis factor-α (anti-TNF-α) treatment and all the above-mentioned assessments were repeated after 2 and 12 weeks of treatment. Treatment, which was successful in reducing disease activity at 2 and 12 weeks, resulted in an improvement in microvascular endothelial-dependent function at 2 weeks, but not at 12 weeks. There was no change in macrovascular endothelial-dependent function or arterial stiffness at any time point, nor in global CVD risk. Finally, a systematic review of the literature pertaining to endothelial function in RA was performed. This revealed that, on the whole, the evidence supporting a relationship between endothelial function and disease-related inflammation was not strong. The findings of these studies suggest that classical CVD risk may be a better predictor of endothelial function in RA than disease-related inflammation.
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