Infliximab an anti-TNF-alpha agent improves left atrial abnormalities in patients with rheumatoid arthritis: preliminary results

摘要

Rheumatoid arthritis (RA) is a systemic autoimmune disease affecting about 1% of the population. It is also characterised by an excess risk of cardiovascular disease and mortality, probably via chronic systemic inflammation. TNF-alpha represents the major inflammatory cytokine in RA patients. Apart from being the major promoter and regulator of the inflammatory cascade resulting in joint damage, it may mediate cardiac injury through a variety of biological mechanisms. Treatment of RA with anti-TNF-alpha agents such as infliximab has been shown to be effective in reducing signs and symptoms of the disease and in preventing joint damage,- but their impact on cardiovascular disease, especially in RA patients with preserved LV function (EF ≥ 50) remains controversial.In this prospective study we tried to elucidate (1) whether myocardial abnormality as assessed by echocardiography is present in RA patients compared to normal controls, (2) the electrocardiographic P-wave changes in RA patients, and (3) the impact of infliximab treatment on left ventricular (LV) and left atrial (LA) echocardiographic parameters in comparison to treatment with corticosteroids. We used conventional and speckle tracking echocardiography (STE), a novel method for the evaluation of myocardial abnormality.