Modest But Sustained Increase of Serum High Density Lipoprotein Cholesterol Levels in Patients with Inflammatory Arthritides Treated with Infliximab
ELIAS SPANAKIS, PRODROMOS SIDIROPOULOS, JOHN PAPADAKIS, EMMANUEL GANOTAKIS, GEORGE KATSIKAS, STYLIANOS KARVOUNARIS, ARGYRO BIZAKI, HERAKLIS KRITIKOS, and DIMITRIOS T. BOUMPAS
Objective. Tumor necrosis factor-a (TNF-a) is a key cytokine in the pathogenesis of chronic inflammatory arthritides, has proatherogenic effects, and may be positively correlated with impairment of the action of insulin. Patients with chronic inflammatory arthritides have an increased risk for cardiovascular diseases. We assessed whether anti-TNF-a treatment modifies the unfavorable lipid profile induced by chronic inflammatory arthritides.
Methods. Sixty patients (24 with rheumatoid arthritis, 26 ankylosing spondylitis, and 10 psoriatic arthritis) receiving infliximab because of ongoing disease activity despite disease modifying drugs (DMARD) were prospectively studied for 6 months. Lipid profile, total cholesterol/high density lipoprotein cholesterol (TC/HDL-C), and low density lipoprotein cholesterol (LDL-C)/HDL-C ratios, as well as disease activity indices (DAS28 and BASDAI), were assessed.
Results. A sustained increase of serum HDL-C was observed [mean increase (95% CI)] 5 (3–7) mg/dl, 3.5 (1–6) mg/dl, and 3 (1–5) mg/dl at 1, 3, and 6 months, respectively (p < 0.01). Compared to nonresponders, HDL-C increased significantly more in EULAR or BASDAI responders (0.8 vs 5.8 mg/dl; p = 0.05). Serum TC was significantly increased [11 (4–8) mg/dl; p = 0.001] only after the first month of treatment. TC/HDL-C and LDL-C/HDL-C decreased only after the first month [0.3 (0.1–0.4), p < 0.01, and 0.2 (0.1–0.4), p < 0.01, respectively]. For patients with baseline LDL-C > 130 mg/dl, LDL-C/HDL-C decreased (p < 0.05) during the whole study period and TC/HDL-C decreased (p < 0.05) at 1 and 3 months.
Conclusion. Anti-TNF-a treatment in patients with chronic inflammatory arthritides induces a modest, but sustained, increase in serum HDL-C levels, which may have a favorable effect in reducing the cardiovascular risk in these patients. (First Release Oct 1 2006; J Rheumatol 2006;33:2440-6)
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From the Department of Rheumatology, Clinical Immunology, and Allergy, and the Department of Internal Medicine, University Hospital, Medical School, University of Crete, Heraklion, Greece.
Supported in part by the AutoCure project and a grant from the Hellenic Rheumatology Society.
E.K. Spanakis, MD, Department of Rheumatology, Clinical Immunology, and Allergy, University Hospital, Medical School, University of Crete, and Department of Medicine, Division of Endocrinology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; P. Sidiropoulos, MD, Department of Rheumatology, Clinical Immunology, and Allergy; J. Papadakis, MD; E. Ganotakis, MD, Department of Internal Medicine; G. Katsikas, MD; S. Karvounaris, MD; A. Bizaki, MD; H. Kritikos, MD, Department of Rheumatology, Clinical Immunology, and Allergy; D.T. Boumpas, MD, Departments of Rheumatology, Clinical Immunology, and Allergy and Internal Medicine, University Hospital, Medical School, University of Crete.
Dr. Spanakis and Dr. Sidiropoulos contributed equally to the project.
Address reprint requests to Dr. P. Sidiropoulos, Department of Rheumatology, University Hospital of Crete, Heraklion 71110, Crete, Greece. E-mail: email@example.com
Accepted for publication July 14, 2006.