Tumour necrosis factor α blockade reduces circulating N-terminal pro-brain natriuretic peptide levels in patients with active rheumatoid arthritis: results from a prospective cohort study
Abstract
Background Patients with rheumatoid arthritis (RA) are at increased risk of heart failure and vascular events. Small increases in circulating N-terminal pro-brain natriuretic peptide (NT-proBNP) are associated with an increased risk of a cardiovascular event, and high levels signal left ventricular dysfunction. Data on the effects of tumour necrosis factor alpha(TNFalpha) blocking agents on circulating NT-proBNP levels in patients with active RA are lacking but may be informative.Methods 171 consecutive patients with RA (28-joint disease activity score >3.2) without congestive heart failure (NYHA class III or IV) were scheduled to receive adalimumab once every 2 weeks. Serum NT-proBNP concentrations were measured simultaneously on stored baseline and 16-week samples. Paired sample t tests were used to observe differences in biomarkers before and after adalimumab administration. Correlations between the biomarkers and changes in circulating log NT-proBNP levels were evaluated with the Pearson test and multivariable linear regression analyses of correlates were performed (forward selection procedure).Results Circulating levels of NT-proBNP decreased significantly after 16 weeks of adalimumab administration (median NT-proBNP 83.0 pg/ml vs 69.5 pg/ml, p=0.004). Changes in NT-proBNP levels were associated with changes in pulse pressure (r=0.18, p=0.02), systolic blood pressure (r=0.16, p=0.04) and erythrocyte sedimentation rate (r=0.18, p=0.02). On multivariable analysis, changes in pulse pressure and erythrocyte sedimentation rate remained independently associated with changes in circulating NT-proBNP levels.Conclusions These observations show that blocking TNFalpha in patients with RA without evident heart failure decreases NT-proBNP levels by about 18%. This suggests no treatment-induced deterioration in cardiac function and a potential cardiovascular risk benefit.
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In chronic inflammatory diseases, serum levels of atrial natriuretic factor and NT-brain natriuretic factor are markedly increased, indicating volume overload.
“there are obvious signs of volume overload in chronic inflammatory diseases because serum levels of atrial natriuretic factor and NT-brain natriuretic factor are markedly increased in different diseases [49–52].”
From Evolutionary medicine and chronic inflammatory state—known and new concepts in pathophysiology (2012) · cites this paper as [51]
NT-brain natriuretic factor decreases with TNF neutralization therapy but increases under therapy with volume retention-inducing glucocorticoids.
“NT-brain natriuretic factor decreased with TNF neutralization therapy but increased under therapy with volume retention—inducing glucocorticoids [49, 51].”
From Evolutionary medicine and chronic inflammatory state—known and new concepts in pathophysiology (2012) · cites this paper as [51]
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- Authors
- Peters, M. J. L., Welsh, P., McInnes, I. B., Wolbink, G., Dijkmans, B. A. C., Sattar, N., & Nurmohamed, M. T.
- Affiliations
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- University of Glasgow (GB)
- Venue
- Annals of the Rheumatic Diseases
- Publisher
- Elsevier BV
- Published
- 2010-07
- Volume
- 69
- Issue
- 7
- Pages
- 1281-1285
- ISSN
- 0003-4967 (ISSN-L)
- OpenAlex
- W2128244718
- Cited by
- 62
- References
- 38
- Citations by year
- 2026: 1 · 2025: 2 · 2023: 1 · 2022: 4 · 2021: 1 · 2020: 6 · 2019: 3 · 2018: 8 · 2017: 2 · 2016: 6 · 2015: 5 · 2014: 2 · 2013: 5 · 2012: 7
- FWCI
- 3.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Annals of the Rheumatic Diseases (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
- Keywords
- rheumatoid arthritis, adalimumab, N-terminal pro-brain natriuretic peptide, NT-proBNP, cardiovascular risk, heart failure, left ventricular dysfunction, pulse pressure, systolic blood pressure, erythrocyte sedimentation rate, cardiac biomarkers
- MeSH terms
- Adalimumab, Adult, Aged, Antibodies, Monoclonal, Arthritis, Rheumatoid, Blood Pressure, Blood Sedimentation, Cardiovascular Diseases, Female, Humans, Male, Middle Aged, Peptide Fragments, Prospective Studies, Risk Factors, Tumor Necrosis Factor-alpha, Biomarkers, Antirheumatic Agents, Natriuretic Peptide, Brain, Antibodies, Monoclonal, Humanized
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