Update of tnf-alpha antagonists and cardiovascular disease in rheumatoid arthritis

Abstract

Tumor necrosis factor-alpha (TNF-alpha) antagonists were unexpectedly found to have no beneficial effects in moderate-to-severe heart failure in two large randomized clinical trials. In certain doses, the agents were found to be harmful. These results have important implications for rheumatoid arthritis (RA). Patients with the disease have an increased risk for developing cardiovascular co-morbidity, including heart failure. Because of the beneficial effect of the TNF-alpha antagonists in the management of RA, these agents have gained widespread use. Rheumatologists and other physicians who provide care for RA are thus likely to encounter candidates for anti-TNF-alpha therapy who have overt or subclinical heart failure. Although data are currently not sufficient to support evidence-based recommendations, it is possible to make reasonable suggestions to guide clinical practice.

Arterial and venous thromboembolic events during anti-TNF therapy: A study of 85 spontaneous reports in the period 2000–2006

“…This is commonly attributed to accelerated atheroscle-rosis as a result of both systemic inflammatory syndrome and high risk factor for cardiovascular disease [13]. Briefly, an inflammatory systemic state can lead by itself to endothelial dysfunction, secondary dyslipidaemia and activation of coagulation [59].…”