Values and Correlations between C-Reactive Protein and Apolipoprotein B after Treatment with Methotrexate at Patients with Rheumatoid Arthritis
DOI:
https://doi.org/10.3889/oamjms.2019.278Keywords:
Rheumatoid arthritis (RA);, Methotrexat (MTX);, C-reactive protein (CRP);, Apolipoprotein B (Apo B);Abstract
BACKGROUND: Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD). Lipid changes related to inflammation have been described in RA. Methotrexate (MTX) treatment is effective in controlling inflammation and decreasing the CRP (C-reactive protein) values.
AIM: To examine the disease activity, CRP and Apo B values in the detection of new patients with active and untreated RA, and impact of MTX therapy on their levels after 6 months and one year of treatment, and the correlation between their values in this period.
METHODS: 80 patients with active and newly discovered RA patients who meet the American Rheumatology Association (ARA) 1987 revised criteria were treated with disease-modifying anti-inflammatory drugs (DMARDs) according to the protocol for treatment.
RESULTS: After a year of therapy RA patients achieved significant decrease in the DAS28 (disease activity score) (p < 0.01 and p < 0.001), and CRP values (p < 0.001). Levels of Apo B values at the 12 months were nonsignificantly higher compared to the results obtained at the beginning of the study (p < 0.001). After 6 and 12 months there was a weak nonsignificant negative correlation about the values of CRP and Apo B at baseline and after 12 months (r = –0.15 and r = -0.12 p > 0.05).
CONCLUSION: Use of MTX therapy at RA patients had a reduced effect on disease activity and inflammation, but the nonsignificance effect on the values of Apo B lipoproteins.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Nurmohamed MT. Atherogenic lipid profiles and its management in patients with rheumatoid arthritis. Vasc Health Risk Manag. 2007; 3(6):845-852.
Lems WF, Dijkmans BAC. Rheumatoid arthritis: clinical aspects and its variants. In: Firestein GS, Panayi GS, Wollheim FA, editors. Rheumatoid arthritis: new frontiers in pathogenesis and treatment. New York: Oxford University Press, 2000:213-25.
Van Doornum S, McGoll G, Wicks IP. Accelerated atherosclerosis: an extraarticular feature of rheumatoid arthritis. Arthritis Rheum. 2002; 46:862-73. https://doi.org/10.1002/art.10089 PMid:11953961
Solomon DH, Karlson EW, Rimm EB, et al. Cardiovascular morbidity and mortality in women diagnosed witch rheumatoid arthritis. Circulation. 2003; 107:1303-7. https://doi.org/10.1161/01.CIR.0000054612.26458.B2 PMid:12628952
Tracey E Toms, Vasileios F Panoulas, and George D Kitas. Dyslipidaemia in Rheumatological Autoimmune Diseases. Open Cardiovasc Med J. 2011; 5: 64-75. https://doi.org/10.2174/1874192401105010064 PMid:21660202 PMCid:PMC3109701
Aamer Saando. Endothelial disfunction in RA. eTheses Repository etheses.bham.ac.uk/1293/1/ Sandoo10PhD.pdf
Galarraga B, Khan F, Kumar P, Pullar T, Belch JJ. C-reactive protein: the underlying cause of microvascular dysfunction in rheumatoid arthritis. Rheumatology (Oxford). 2008; 47:1780-1784. https://doi.org/10.1093/rheumatology/ken386 PMid:18854346
Sattar N, McCarey DW, Capell H, McInnes IB. Explaining how "high-grade" systemic inflammation accelerates vascular risk in rheumatoid arthritis. Circulation. 2003; 108:2957-2963. https://doi.org/10.1161/01.CIR.0000099844.31524.05 PMid:14676136
Vaudo G, Marchesi S, Gerli R, Allegrucci R, Giordano A, Siepi D, Pirro M, Shoenfeld Y, Schillaci G, Mannarino E: Endothelial dysfunction in young patients with rheumatoid arthritis and low disease activity. Ann Rheum Dis. 2004, 63:31-35.
Kerekes G, Szekanecz Z, Der H, Sandor Z, Lakos G, Muszbek L, Csipo I, Sipka S, Seres I, Paragh G, Kappelmayer J, Szomjak E, Veres K, Szegedi G, Shoenfeld Y, Soltesz P. Endothelial dysfunction and atherosclerosis in rheumatoid arthritis: a multiparametric analysis using imaging techniques and laboratory markers of inflammation and autoimmunity. J Rheumatol. 2008; 35:398-406.
Stamatelopoulos KS, Kitas GD, Papamichael CM, Chryssohoou E, Kyrkou K, Georgiopoulos G, Protogerou A, Panoulas VF, Sandoo A, Tentolouris N, Mavrikakis M, Sfikakis PP: Atherosclerosis in Rheumatoid Arthritis Versus Diabetes: a comparative study. Arterioscler Thromb Vasc Biol. 2009; 29:1702-8. https://doi.org/10.1161/ATVBAHA.109.190108
Walldius G1, Jungner I. The apoB/apoA-I ratio: a strong, new risk factor for cardiovascular disease and a target for lipid-lowering therapy--a review of the evidence. J Intern Med. 2006; 259(5):493-519. https://doi.org/10.1111/j.1365-2796.2006.01643.x PMid:16629855
Choy E, Ganeshalingam K, Semb AG, Szekanecz Z, Nurmohamed M. Cardiovascular risk in rheumatoid arthritis: recent advances in the understanding of the pivotal role of inflammation, risk predictors and the impact of treatment. Rheumatology (Oxford). 2014; 53(12):2143-2154. https://doi.org/10.1093/rheumatology/keu224 PMid:24907149 PMCid:PMC4241890
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106:3143-421. https://doi.org/10.1161/circ.106.25.3143
Semb AG, Kvien TK, Aastveit AH, et al. Lipids, myocardial infarction and ischaemic stroke in patients with rheumatoid arthritis in the Apolipoprotein-related Mortality RISk (AMORIS) Study. Ann Rheum Dis. 2010; 69:1996-2001. https://doi.org/10.1136/ard.2009.126128 PMid:20551156
Nair N. Should We Measure Apolipoproteins to Evaluate Coronary Heart Disease Risk? Cardiology. 2012.
Clinical Correlations. The NYU Langone Online Journal of Medicine. 2012.
Jonathan L. Marks and Christopher J. Edwards. Protective effect of methotrexate in patients with rheum. arthritis and cardiovascular comorbidity. Ther Adv Musculoskelet Dis. 2012; 4(3):149-157. https://doi.org/10.1177/1759720X11436239
Mok CC. EULAR recommendations for the management of rheumatoid arthritis: what is new in 2017 and its applicability in our local setting. Hong Kong Bulletin on Rheumatic Diseases. 2017; 17(2):47-52. https://doi.org/10.1515/hkbrd-2017-0009
Arida A, Protogerou AD, Kitas GD, Sfikakis PP. Systemic Inflammatory Response and Atherosclerosis: The Paradigm of Chronic Inflammatory Rheumatic Diseases. Int J Mol Sci. 2018; 19(7). https://doi.org/10.3390/ijms19071890
Hensel B, Bruckert E. Lipid profile and cardiovascular risk in patients with rheumatoid arthritis: effect of the disease and drug therapy. Ann Endocrinol (Paris). 2010; 71:257-63.
Gonzalez-Gay MA, Gonzalez-Juanatey C, Pineiro A, Garcia-Porrua C, Testa A, et al. High-grade C-reactive protein elevation correlates with accelerated atherogenesis in patients with rheumatoid arthritis. J Rheumatol. 2005; 32:1219-23.
Galarraga B, Khan F, Kumar P, Pullar T, Belch JJ. C-reactive protein: the underlying cause of microvascular dysfunction in rheumatoid arthritis. Rheumatology. 2008; 47:1780-4. https://doi.org/10.1093/rheumatology/ken386 PMid:18854346
López-MejÃas R, et al. Influence of elevated-CRP level-related polymorphisms in non-rheumatic Caucasians on the risk of subclinical atherosclerosis and cardiovascular disease in rheumatoid arthritis. Sci Rep. 2016; 6:31979. https://doi.org/10.1038/srep31979 PMid:27534721 PMCid:PMC4989194
Solomon DH, Kremer J, Curtis JR, Hochberg MC, Reed G, Tsao P, et al. Explaining the cardiovascular risk associated with rheumatoid arthritis: traditional risk factors versus markers of rheumatoid arthritis severity. Ann Rheum Dis. 2010; 69(11):1920-5. https://doi.org/10.1136/ard.2009.122226 PMid:20444756 PMCid:PMC2963658
Walldius G, Jungner I. The apoB/apoA-I ratio: a strong, new risk factor for cardiovascular disease and a target for lipid-lowering therapy--a review of the evidence. J Intern Med. 2006; 259(5):493-519. https://doi.org/10.1111/j.1365-2796.2006.01643.x PMid:16629855
Jamnitski A, Visman IM, Peters MJ, Dijkmans BA, Voskuyl AE, Nurmohamed MT. Beneficial effect of 1-year etanercept treatment on the lipid profile in responding patients with rheumatoid arthritis: the ETRA study. Ann Rheum Dis. 2010; 69(11):1929-33. https://doi.org/10.1136/ard.2009.127597 PMid:20498216
Dunder K, Lind L, Zethelius B, Berglund L, Lithell H. Evaluation of a scoring scheme, including proinsulin and the apolipoprotein B/apolipoprotein AI ratio, for the risk of acute coronary events in middleâ€aged men: Uppsala Longitudinal Study of Adult Men (ULSAM). Am Heart J. 2004; 148: 596-601. https://doi.org/10.1016/j.ahj.2004.03.021 PMid:15459588
Liao KP, Playford MP, Frits M, Coblyn JS, Iannaccone C, Weinblatt ME, Shadick NS, Mehta NN. The association between reduction in inflammation and changes in lipoprotein levels and HDL cholesterol efflux capacity in rheumatoid arthritis. Journal of the American Heart Association. 2015; 4(2):e001588. https://doi.org/10.1161/JAHA.114.001588
Parveen S, Jacob R, Rajasekhar L, Srinivasa C and Mohan IK. Serum Lipid Alterations in Early Rheumatoid Arthritis Patients on Disease Modifying Anti Rheumatoid Therapy. Indian J Clin Biochem. 2017; 32(1):26-32. https://doi.org/10.1007/s12291-016-0566-9 PMid:28149009 PMCid:PMC5247364
Magaro M, Altomonte L, Zoli A, Mirone L, Ruffini MP. Serum lipid pattern and apolipoproteins in active rheumatoid arthritis. Z Rheumatol. 1991; 50:168-170.
Hurt-Camejo E, Paredes S, Masana L, Camejo G, Sartipy P, Rosengren B, et al. Elevated levels of small, low density lipoprotein with high affinity for arterial matrix components in patients with rheumatoid arthritis: possible contribution of phospholipase A2 to this atherogenic profile. Arthritis Rheum. 2001; 44:2761-2767. https://doi.org/10.1002/1529-0131(200112)44:12<2761::AID-ART463>3.0.CO;2-5
Roubille C, Richer V, Starnino T. at al. The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2015; 74(3):480-9. https://doi.org/10.1136/annrheumdis-2014-206624 PMid:25561362 PMCid:PMC4345910
[No authors listed] Rheumatoid arthritis: choice of antirheumatic treatment. Methotrexate first. Prescrire Int. 2010; 19(105):30-4.
Westlake SL, Colebatch AN, Baird J at al. The effect of methotrexate on cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review. Rheumatology (Oxford). 2010; 49(2):295-307. https://doi.org/10.1093/rheumatology/kep366 PMid:19946022
Świerkot J, Batko B, Wiland P, Jędrzejewski M, Stajszczyk M. Methotrexate treatment for rheumatoid arthritis in Poland: Retrospective analysis of patients in routine clinical practice. Reumatologia. 2018; 56(1):3-9. https://doi.org/10.5114/reum.2018.74741 PMid:29686436 PMCid:PMC5911651
Giollo A, Bissell LA, Buch MH. Cardiovascular outcomes of patients with rheumatoid arthritis prescribed disease modifying anti-rheumatic drugs: a review. Expert Opin Drug Saf. 2018; 17(7):697-708. https://doi.org/10.1080/14740338.2018.1483331 PMid:29871535
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 Hysni Ismaili, Levent Ismaili, Meral Rexhepi
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0