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

Rajdip Dulai, Mark Perry, Richard Twycross-Lewis, Dylan Morrissey, Fabiola Atzeni, Stephen Greenwald

Research output: Contribution to journalArticlepeer-review


Background: There is evidence that patients with rheumatoid arthritis (RA) have a higher arterial tiffness than their age-matched healthy counterparts and thus have a higher cardiovascular risk. Under National Institute for Clinical Excellence guidelines, tumor necrosis factor-α (TNF-α) antagonists are indicated clinically in patients with severe active rheumatoid disease. TNF-α 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-α 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-α 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-α 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-α antagonists, different outcome measures being used, and differences in follow-up. Conclusions: The balance of evidence suggests that TNF-α 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.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalSeminars in Arthritis and Rheumatism
Issue number1
Publication statusPublished - Aug 2012


  • Arterial stiffness
  • Augmentation index
  • Pulse wave velocity
  • Rheumatoid arthritis
  • TNF-α antagonists

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine


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