Showing papers by "Tomas R. Vazquez-Rodriguez published in 2008"

Short-term improvement of endothelial function in rituximab-treated rheumatoid arthritis patients refractory to tumor necrosis factor α blocker therapy

Abstract: Objective Cardiovascular disease is the major cause of excessive mortality in rheumatoid arthritis (RA) and endothelial dysfunction plays a key role in atherosclerosis. The aim of the present study was to assess whether rituximab therapy was able to improve endothelial function in RA patients refractory to tumor necrosis factor α (TNFα) blockers. Methods Six consecutive RA patients (5 women; age range 55–79 years) with active disease refractory to TNFα inhibitor therapy were studied. Patients received intravenous rituximab (1 course, consisting of 2 infusions of 1,000 mg each separated by 2 weeks). Flow-mediated endothelium-dependent vasodilatation (FMD%) and endothelium-independent vasodilatation (postnitroglycerin) were measured at day 0 prior to the first rituximab infusion, at week 2 (before the second infusion), and at month 6. Results At week 2, a dramatic increase in FMD% values was observed in all patients (mean ± SD 7.02 ± 2.31%, median 7.29%, range 3.2–9.75%) compared with those observed before the first infusion (mean ± SD 3.35 ± 1.58%, median 3.04%, range 1.69–5.89%). In addition, at month 6, FMD% values in all patients (mean ± SD 7.66 ± 1.73%, median 7.64%, range 5.61–9.98%) were greater than those found before the first infusion (P = 0.03). The dramatic improvement of FMD% was associated with a significant decrease in C-reactive protein level and Disease Activity Score in 28 joints. Conclusion Our study demonstrates an active effect of rituximab on endothelial function in RA patients refractory to TNFα blockers.

Anti-TNF-alpha therapy modulates resistin in patients with rheumatoid arthritis.

Abstract: Objective Chronic systemic infl ammation plays a pivotal role in the development of atherosclerosis in rheumatoid arthritis (RA). In the present study, we investigated whether anti-TNF-α antagonist-monoclonal antibody-infl iximab administration alters α antagonist-monoclonal antibody-infl iximab administration alters α circulating levels of resistin, a proinfl ammatory adipokine. We further assessed associations of circulating resistin concentrations with CRP and ESR levels, platelet counts and metabolic syndrome and demographic characteristics in RA patients on periodical treatment with infl iximab. Methods We investigated 33 patients with RA on periodical treatment with infl iximab. Serum resistin levels were determined immediately prior to and after infl iximab infusion. Results Upon infl iximab administration, mean (SD) serum resistin concentrations (ng/ml) decreased from 21.9 (9.9) to 17.4 (8.9) (p=0.005). Also, a signifi cant association between the mean ESR (r=0.405; p=0.03) and CRP (r=0.571; p=0.0005) from disease diagnosis and ESR (r=0.486; p=0.004), CRP (r=0.599; p=0.0005) and platelet count (r=0.559; p=0.0007) at the time of the study and baseline resistin levels was found. Conclusions The present study shows that anti-TNF-α therapy results in a rapid reduction of serum resistin levels in patients with RA. α therapy results in a rapid reduction of serum resistin levels in patients with RA. α It also confi rms a close association between laboratory markers of infl ammation, particularly CRP and resistin levels. These observations support a potential role of resistin in the infl ammatory cascade in RA.

Anti-tumour necrosis factor α therapy modulates ghrelin in patients with severe rheumatoid arthritis

Abstract: The mechanisms involved in inflammation related accelerated atherosclerosis and cardiovascular disease in rheumatoid arthritis (RA) require further study.1 Ghrelin, the endogenous ligand for the growth hormone secretagogue receptor, a gastric peptide playing a role in the appetite regulation, possesses anti-inflammatory properties.2 Otero et al showed reduced ghrelin plasma concentrations in patients with RA compared to controls.3 Improvement of insulin resistance in patients with severe disease who started anti-tumour necrosis factor (TNF)α therapy has been described previously.4 Additionally, we have reported a rapid improvement in endothelial dysfunction5 and insulin sensitivity6 following the infusion of the chimeric anti-TNFα/monoclonal antibody/infliximab in patients with RA with severe disease on periodical treatment with this drug. Moreover, inhibition of basal …

Localized vasculitis of the gastrointestinal tract: a case report and literature review.

Abstract: Localized gastrointestinal vasculitis is a rare condition. It may be observed as an incidental unexpected pathologic finding at the time of biopsy of an abdominal mass or may present as unexplained abdominal pain with or without unexplained lower gastrointestinal bleeding. In this report we describe a new case of localized polyarteritis nodosa with involvement of peripancreatic middle-sized blood vessels. A literature review of cases of localized gastrointestinal vasculitis was also conducted. A major point of concern is whether a single organ vasculitis of the gastrointestinal tract is actually a localized gastrointestinal vasculitis or simply an initial manifestation of a more severe systemic vasculitis. Due to this, in cases of localized gastrointestinal vasculitis a complete evaluation of the patient to exclude the presence of a systemic a potentially threatening systemic vasculitis is required.

Subclinical atherosclerosis in patients with psoriatic arthritis.

Abstract: To the Editor: In the May 2008 issue, Eder, et al reported the presence of subclinical atherosclerosis, determined by high-resolution carotid ultrasonography, in 40 unselected patients diagnosed with psoriatic arthritis (PsA)1. The authors concluded that subclinical atherosclerosis in PsA may not be attributed solely to the presence of traditional cardiovascular (CV) risk factors1. We entirely agree with this assumption. In this regard, in 2007 we described the presence of endothelial dysfunction, considered as an early development in the atherogenesis process2, in patients with PsA without previous history of CV events or traditional CV risk factors3. More important, using high-resolution carotid…

C-Reactive Protein Gene Polymorphisms in Biopsy-proven Giant Cell Arteritis from Northwestern Spain

Abstract: Objective. To investigate the potential implication of several polymorphisms of the C-reactive protein (CRP) gene in the predisposition to or clinical expression of giant cell arteritis (GCA). Methods. A total of 125 patients diagnosed with biopsy-proven GCA and 234 ethnically matched controls from the Lugo region of Northwestern Spain were included in our study. Four functional gene polymorphisms for CRP rs1417938, rs1800947, rs1205, and rs3093059 variants were assessed using a polymerase chain reaction system with predeveloped TaqMan allelic discrimination assay. Results. Although we observed a significant increase in the frequency of heterozygotes for rs1417938 A/T [odds ratio (OR) = 1.70; 95% confidence interval (CI) 1.04–2.80; p = 0.03] and rs1205 C/T (OR 1.73; 95% CI 1.07–2.78; p = 0.02) in patients with GCA, no statistically significant differences in the allelic frequencies of these 2 polymorphisms were found between patients with GCA and controls. A marginal significant increase in the frequency of rs3093059 allele T in patients with GCA compared to controls was observed (OR 1.81; 95% CI 0.97–3.39; p = 0.04). However, the increased frequency of patients with GCA homozygous for rs3093059 T/T in patients with GCA compared to controls was out of the range of significance (OR 1.77; 95% CI 0.92–3.40; p = 0.07). No significant differences were found when we stratified patients with GCA according to the presence of polymyalgia rheumatica or severe ischemic complications of the disease. Conclusion. The functional CRP gene polymorphisms assessed in our study do not seem to play a major role in the pathogenesis of GCA in individuals from Northwestern Spain.

Carotid intima-media thickness and endothelial function: useful surrogate markers for establishing cardiovascular risk in patients with inflammatory rheumatic disease

Abstract: We read with interest the editorial by Veldhuijzen van Zanten and Kitas [1], in which they consider whether carotid artery intima-media thickness (IMT) – a surrogate marker of atherosclerosis – might be a good predictor of future cardiovascular events in patients with rheumatoid arthritis (RA). They state that it remains an open question, because no long-term studies have documented such an association in patients with RA. We are pleased to provide the readers of this journal with an answer to this question. We recently reported [2] that carotid artery IMT had good ability to predict development of cardiovascular events over a 5-year period of follow up in 47 patients with RA without clinically evident cardiovascular disease at the time of evaluation by carotid ultrasonography. In our study carotid IMT, categorized in quartiles, was strongly associated with cardiovascular events; specifically, none of the RA patients with carotid IMT less than 0.77 mm suffered cardiovascular events. However, six of the 10 patients with carotid IMT greater than 0.91 mm experienced cardiovascular events. When logistic regression models were performed, carotid IMT at the time of ultrasonographic study had high power to predict development of cardiovascular events over the 5-year period of follow up. Although the area under the receiver operating characteristic curve was 0.86 when using age at the onset of the study, it was greater in models that included carotid IMT. In this regard, the area under the receiver operating characteristic curve was 0.93 for a model that included only carotid IMT. Based on these findings, we propose that ultrasonographic assessment of the carotid artery should be performed in all patients with RA in order to identify the subgroup of patients at high risk for cardiovascular complications. In the same editorial, Veldhuijzen van Zanten and Kitas [1] emphasize that endothelial function is highly dependent on current levels of inflammation. We agree entirely with the authors on this point; we observed endothelial dysfunction in patients with biopsy-proven giant cell arteritis (GCA) – an inflammatory disease that involves large and middle-sized blood vessels. However, steroid therapy was able to improve endothelial function. This effect was observed when laboratory markers of inflammation returned to normal levels [3]. Whether normalization of endothelial function might lead to 'protection' against development of accelerated atherosclerosis in chronic inflammatory diseases remains to be determined, but this is in intriguing possibility. It could explain why GCA mortality in very distant regions (such as Rochester, Minnesota, USA and Lugo, north west Spain) is comparable to that observed in the general population of the same age [4]. In this regard, we recently reported that the carotid IMT was not increased in biopsy-proven GCA patients who had ended steroid therapy compared with matched control individuals from the same population [5]. Taking all of these considerations into account, we support the use of surrogate markers to determine the cardiovascular risk of patients with inflammatory rheumatic diseases.

Case reports Localized vasculitis of the gastrointestinal tract: a case report and literature review

Abstract: Localized gastrointestinal vasculitis is a rare condition. It may be observed as an incidental unexpected patho- logic fi nding at the time of biopsy of an abdominal mass or may present as unexplained abdominal pain with or without unexplained lower gas- trointestinal bleeding. In this report we describe a new case of localized polyarteritis nodosa with involvement of peripancreatic middle-sized blood vessels. A literature review of cases of localized gastrointestinal vasculi- tis was also conducted. A major point of concern is whether a single organ vasculitis of the gastrointestinal tract is actually a localized gastrointestinal vasculitis or simply an initial mani- festation of a more severe systemic vasculitis. Due to this, in cases of lo- calized gastrointestinal vasculitis a complete evaluation of the patient to exclude the presence of a systemic a potentially threatening systemic vas- culitis is required.