Clinical Rheumatology

, Volume 29, Issue 7, pp 723–727

Augmentation index in patients with rheumatoid arthritis and ankylosing spondylitis treated with infliximab

  • Herwig Pieringer
  • Ulrike Stuby
  • Erich Pohanka
  • Georg Biesenbach
Original Article


Premature atherosclerosis is linked to inflammation. Arterial stiffness is a marker of vascular dysfunction. We tested the hypothesis that treatment with infliximab, which is effective in reducing inflammation in rheumatoid arthritis (RA) and ankylosing spondylitis (AS), also lowers the augmentation index (AIx) in patients with active disease. We also analyzed the subendocardial viability ratio (SEVR), which is a measure of myocardial perfusion relative to cardiac workload. Included in the study were 30 patients (17 RA, 13 AS). Conventional treatment failed in all patients. The AIx and SEVR were determined by radial applanation tonometry before and after treatment with infliximab, at baseline and at week 7. After treatment with infliximab, Disease Activity Score for 28 joints (RA patients), Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index (AS patients), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) improved significantly (p < 0.001). The AIx for all patients increased from 22.0 ± 14.0% to 24.6 ± 13.0% (p = 0.03). The increase in the RA sub-group (p = 0.01) was also significant. The SEVR decreased from 148.6 ± 23.7% to 141.2 ± 23.7% (p = 0.04). Infliximab did not reduce the AIx in patients with RA and AS, although there were clinical improvements and CRP and ESR decreased. Instead, the AIx increased. This could negatively influence cardiac workload.


Ankylosing spondylitis Augmentation index Infliximab Rheumatoid arthritis 


  1. 1.
    Doornum V, McColl G, Wicks IP (2002) Accelerated atherosclerosis. An extraarticular feature of rheumatoid arthritis? Arthritis Rheum 46:862–873CrossRefPubMedGoogle Scholar
  2. 2.
    Klocke R, Cockcroft JR, Taylor GJ, Hall IR, Blake DR (2003) Arterial stiffness and central blood pressure, as determined by pulse wave analysis, in rheumatoid arthritis. Ann Rheum Dis 62:414–418CrossRefPubMedGoogle Scholar
  3. 3.
    Pieringer H, Schumacher S, Stuby U, Biesenbach G. Semin Arthritis Rheum. 2009 Dec;39(3):163-9. Epub 2008 Sep 27Google Scholar
  4. 4.
    Peters MJ, van der Horst-Bruinsma IE, Dijkmans BA, Nurmohamed MT (2004) Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum 34:585–592CrossRefPubMedGoogle Scholar
  5. 5.
    Sari I, Okan T, Akar S, Cece H, Altay C, Secil M, Birlik M, Onen F, Akkoc N (2006) Impaired endothelial function in patients with ankylosing spondylitis. Rheumatology (Oxford) 45:283–286CrossRefGoogle Scholar
  6. 6.
    Wilkinson IB, MacCallum H, Rooijmans DF, Murray GD, Cockcroft JR, McKnight JA, Webb DJ (2000) Increased augmentation index and systolic stress in type 1 diabetes mellitus. QJM 93:441–448CrossRefPubMedGoogle Scholar
  7. 7.
    Brooks B, Molyneaux L, Yue DK (1999) Augmentation of central arterial pressure in type 1 diabetes. Diabetes Care 22:1722–1727CrossRefPubMedGoogle Scholar
  8. 8.
    Weber T, Auer J, O’Rourke MF, Kvas E, Lassnig E, Berent R, Eber B (2004) Arterial stiffness, wave reflections, and the risk of coronary artery disease. Circulation 109:184–189CrossRefPubMedGoogle Scholar
  9. 9.
    Weber T, Auer J, O'Rourke MF, Kvas E, Lassnig E, Lamm G, Stark N, Rammer M, Eber B (2005) Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions. Eur Heart J 26:2657–2663CrossRefPubMedGoogle Scholar
  10. 10.
    Lipsky PE, van der Heijde DM, St Clair EW, Furst DE, Breedveld FC, Kalden JR, Smolen JS, Weisman M, Emery P, Feldmann M, Harriman GR, Maini RN, Anti-Tumor Necrosis Factor Trial in Rheumatoid Arthritis with Concomitant Therapy Study Group (2000) Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-tumor necrosis factor trial in rheumatoid arthritis with Concomitant Therapy Study Group. N Engl J Med 343:1594–1602CrossRefPubMedGoogle Scholar
  11. 11.
    Braun J, Brandt J, Listing J, Zink A, Alten R, Golder W, Gromnica-Ihle E, Kellner H, Krause A, Schneider M, Sorensen H, Zeidler H, Thriene W, Sieper J (2002) Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial. Lancet 359:1187–1193CrossRefPubMedGoogle Scholar
  12. 12.
    Ross R (1999) Atherosclerosis—an inflammatory disease. N Engl J Med 340:115–126CrossRefPubMedGoogle Scholar
  13. 13.
    Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324CrossRefPubMedGoogle Scholar
  14. 14.
    van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27:361–368CrossRefPubMedGoogle Scholar
  15. 15.
    Wilkinson IB, MacCallum H, Flint L, Cockcroft JR, Newby DE, Webb DJ (2000) The influence of heart rate on augmentation index and central arterial pressure in humans. J Physiol 525:263–270CrossRefPubMedGoogle Scholar
  16. 16.
    Van Doornum S, McColl G, Wicks IP (2005) Tumour necrosis factor antagonists improve disease activity but not arterial stiffness in rheumatoid arthritis. Rheumatology (Oxford) 44:1428–1432CrossRefGoogle Scholar
  17. 17.
    Mäki-Petäjä KM, Hall FC, Booth AD, Wallace SM, Yasmin BPW, Harish S, Furlong A, McEniery CM, Brown J, Wilkinson IB (2006) Rheumatoid arthritis is associated with increased aortic pulse-wave velocity, which is reduced by anti-tumor necrosis factor-alpha therapy. Circulation 114:1185–1192CrossRefPubMedGoogle Scholar
  18. 18.
    Hurlimann D, Forster A, Noll G, Enseleit F, Chenevard R, Distler O, Bechir M, Spieker LE, Neidhart M, Michel BA, Gay RE, Luscher TF, Gay S, Ruschitzka F (2002) Anti-tumor necrosis factor-alpha treatment improves endothelial function in patients with rheumatoid arthritis. Circulation 106:2184–2187CrossRefPubMedGoogle Scholar
  19. 19.
    Gonzalez-Juanatey C, Testa A, Garcia-Castelo A, Garcia-Porrua C, Llorca J, Gonzalez-Gay MA (2004) Active but transient improvement of endothelial function in rheumatoid arthritis patients undergoing long-term treatment with anti-tumor necrosis factor alpha antibody. Arthritis Rheum 51:447–450CrossRefPubMedGoogle Scholar
  20. 20.
    Irace C, Mancuso G, Fiaschi E, Madia A, Sesti G, Gnasso A (2004) Effect of anti TNFalpha therapy on arterial diameter and wall shear stress and HDL cholesterol. Atherosclerosis 177:113–118CrossRefPubMedGoogle Scholar
  21. 21.
    Matsui Y, Eguchi K, Shibasaki S, Ishikawa J, Hoshide S, Pickering T, Shimada K, Kario K (2008) Monitoring of the central pulse pressure is useful for detecting cardiac overload during antiadrenergic treatment: the Japan Morning Surge 1 study. J Hypertens 26:1928–1934CrossRefPubMedGoogle Scholar
  22. 22.
    Kingwell BA, Waddell TK, Medley TL, Cameron JD, Dart AM (2002) Large artery stiffness predicts ischemic threshold in patients with coronary artery disease. J Am Coll Cardiol 40:773–779CrossRefPubMedGoogle Scholar
  23. 23.
    Chung ES, Packer M, Lo KH, Fasanmade AA, Willerson JT, Anti-TNF Therapy Against Congestive Heart Failure Investigators (2003) Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the Anti-TNF therapy against congestive heart failure (ATTACH) trial. Circulation 107:3133–3140CrossRefPubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2010

Authors and Affiliations

  • Herwig Pieringer
    • 1
  • Ulrike Stuby
    • 1
  • Erich Pohanka
    • 1
  • Georg Biesenbach
    • 1
  1. 1.Section of Rheumatology, 2nd Department of MedicineGeneral Hospital LinzLinzAustria

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