Influence of anti‑TNF therapy and homocysteine level on carotid intima‑media thickness in rheumatoid arthritis patients

Anghel,Daniela; Sîrbu,Carmen Adella; Hoinoiu,Elena-Mădălina; Petrache,Oana-Georgiana; Pleșa,Cristina-Florentina; Negru,Maria Magdalena; Ioniţă‑Radu,Florentina

doi:10.3892/etm.2021.10981

Influence of anti‑TNF therapy and homocysteine level on carotid intima‑media thickness in rheumatoid arthritis patients

Authors:
- Daniela Anghel
- Carmen Adella Sîrbu
- Elena-Mădălina Hoinoiu
- Oana-Georgiana Petrache
- Cristina-Florentina Pleșa
- Maria Magdalena Negru
- Florentina Ioniţă‑Radu
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Affiliations: Department of Internal Medicine, Central Military Emergency University Hospital, 010242 Bucharest, Romania, Department of Medico‑Surgical and Prophylactic Disciplines, Faculty of Medicine, ‘Titu Maiorescu’ University, 031593 Bucharest, Romania, Department of Neurology, Central Military Emergency University Hospital, 010242 Bucharest, Romania, Department of Internal Medicine and Rheumatology, ‘Sf. Maria’ Clinical Hospital, 011172 Bucharest, Romania, Department of Internal Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020022 Bucharest, Romania
Published online on: November 18, 2021 https://doi.org/10.3892/etm.2021.10981
Article Number: 59

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Abstract

It is a well-known fact that disruptions in the immune system and systemic inflammation are associated with accelerated atherosclerosis in rheumatoid arthritis (RA) patients. Elevated levels of tumor necrosis factor α (TNF‑α), a major pro‑inflammatory cytokine, are involved in endothelial cell activation of medium and large arteries, leading to increased endothelial permeability, generation of superoxide anion radical and hydrogen peroxide, and decreased availability of nitric oxide (NO). The present study aims to determine the influence of anti‑TNF therapy and homocysteine (Hcy) levels on the carotid intima‑media thickness (IMT) in patients with RA. Assessments were performed on 115 patients diagnosed with RA on biological treatment to determine the evolution of IMT and Hcy levels. Carotid ultrasonography was used to assess the IMT, as a fast and easy tool for the prediction of cardiovascular events in patients with RA. The first measurement of IMT was noted as IMT1, followed by a second measurement after 1 year, noted as IMT2. The group of patients was divided into approximately three equal groups, each being treated with a different biological product, respectively, etanercept, adalimumab, and infliximab. In the 3 groups, after 1 year of anti‑TNF‑α therapy, IMT2 progression was significantly reduced compared to baseline. No significant differences were found among the three groups of treatment. A strong association was observed between IMT1‑IMT2 in the etanercept group (P<0.001, r=0.758), in the adalimumab group (P<0.001, r=0.761) and in the infliximab group (P<0.001, r=0.829). The low level of Hcy2 after 12 months of anti‑TNF‑α therapy was significantly correlated with a decrease in IMT2 (P<0.001) in patients who had a high level of Hcy and IMT >0.9 mm at baseline. The results from the present study showed that biological treatment and the low level of homocysteinemia reduced the cardiovascular risk in RA, regardless of the treatment chosen (infliximab, adalimumab, or etanercept).

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