The Effect of Tumor Necrosis Factor-α Antagonists on Arterial Stiffness in Rheumatoid Arthritis: A Literature Review

Background: There is evidence that patients with rheumatoid arthritis (RA) have a higher arterial stiffness than their age-matched healthy counterparts and thus have a higher cardiovascular risk. Under National Institute for Clinical Excellence guidelines, tumor necrosis factor-alpha (TNF-alpha) antagonists are indicated clinically in patients with severe active rheumatoid disease. TNF-alpha antagonists have been found to reduce inflammatory markers in RA; however, it is debatable if they have favorable effects on the cardiovascular system. This review evaluates the effect of TNF-alpha antagonists on arterial stiffness, a predictor of cardiovascular disease, in RA patients. Search strategy: A search of Ovid MEDLINE and ISI Web of Knowledge databases was conducted to identify studies into the effect of TNF-alpha antagonists on arterial stiffness in RA patients. Eight studies matching the search criteria were included for analysis. Findings: Two methods were used to assess arterial stiffness: pulse wave velocity and augmentation index. Despite inconsistencies in augmentation index values, aortic pulse wave velocity in all but one study was significantly reduced following TNF-alpha antagonist treatment. Most studies had methodological limitations, including inadequate sample size, nonblinding of those involved in the measurements, and inadequate inclusion/exclusion criteria. Variation in results could be due to the use of different TNF-alpha antagonists, different outcome measures being used, and differences in follow-up. Conclusions: The balance of evidence suggests that TNF-alpha antagonists may have a beneficial effect on arterial stiffness and therefore cardiovascular risk. However, larger more robust longer term studies are warranted to confirm recent findings. (C) 2012 Elsevier Inc. All rights reserved. Semin Arthritis Rheum 42:1-8