on August 15, 2002
Published online before print August 15, 2002, doi: 10.1161/01.ATV.0000033516.73864.4E
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Submitted on June 25, 2002
Accepted on July 15, 2002
Impaired Responsiveness to NO in Patients Newly Diagnosed With Rheumatoid Arthritis
Robert Bergholm ;
From the Department of Medicine, Divisions of Diabetes (R.B., S.V., S.M., H.Y.-J.), Rheumatology (M.L.-R.), and Cardiology (M.-R.T.), University of Helsinki, Helsinki, Finland.
* To whom correspondence should be addressed. E-mail: ykijarvi{at}helsinki.fi.
Objective—Cardiovascular disease is the major cause of excessive mortality in patients with rheumatoid arthritis (RA). We determined whether endothelial dysfunction characterizes patients newly diagnosed with RA (n=10) compared with normal subjects (control group, n=33) and whether it is reversible with 6 months of anti-inflammatory therapy.
Methods and Results—Endothelial function was determined by measuring vasodilatory responses to intrabrachial artery infusions of acetylcholine (ACh at 7.5 and 15 µg/min, low and high dose, respectively), an endothelium-dependent vasodilator, and to sodium nitroprusside (SNP, 3 and 10 µg/min), an endothelium-independent vasodilator. Before treatment, blood flow responses (fold increase in flow) to low-dose SNP were 30% lower in the RA versus the control group (4.1±0.4-fold versus 5.9±0.5-fold, respectively), and responses to high-dose SNP were 34% lower in the RA group versus the control group (5.1±0.6-fold versus 7.7±0.7-fold, respectively; P<0.001). The responses to low-dose ACh were 50% lower in the RA group versus the control group (3.0±0.5-fold versus 6.6±0.7-fold, respectively), and responses to high-dose ACh were 37% lower in the RA group versus the control group (5.0±0.4-fold versus 7.9±0.8-fold, respectively; P<0.001). After therapy, clinical and laboratory markers of inflammation had significantly decreased. Blood flow responses to ACh increased significantly (P=0.02).
Conclusions—We conclude that newly diagnosed patients with RA have vascular dysfunction, which is reversible with successful therapy. Therefore, early suppression of inflammatory activity may reduce long-term vascular damage.
Key words: atherosclerosis • blood vessels • vasodilatation
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