Retinal microvascular alterations in patients with active rheumatoid arthritis without cardiovascular risk factors: the potential effects of T cell co-stimulation blockade
BackgroundThe evaluation of microvascular alterations might provide clinically useful information for patients with an increased cardiovascular (CV) risk, such as those with rheumatoid arthritis (RA), being the small artery remodeling the earliest form of target organ damage in primary CV diseases,...
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2024.1247024/full |
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| author | Silvia Piantoni Francesca Regola Fabrizio Angeli Alessia Caproli Annalisa Trovati Cesare Tomasi Giulia Chiarini Claudia Rossini Claudia Agabiti Rosei Carolina De Ciuceis Franco Franceschini Maria Lorenza Muiesan Damiano Rizzoni Paolo Airò |
| author_facet | Silvia Piantoni Francesca Regola Fabrizio Angeli Alessia Caproli Annalisa Trovati Cesare Tomasi Giulia Chiarini Claudia Rossini Claudia Agabiti Rosei Carolina De Ciuceis Franco Franceschini Maria Lorenza Muiesan Damiano Rizzoni Paolo Airò |
| author_sort | Silvia Piantoni |
| collection | DOAJ |
| description | BackgroundThe evaluation of microvascular alterations might provide clinically useful information for patients with an increased cardiovascular (CV) risk, such as those with rheumatoid arthritis (RA), being the small artery remodeling the earliest form of target organ damage in primary CV diseases, such as arterial hypertension. The evaluation of retinal arterioles is a non-invasive technique aimed to identify an early microvascular damage, represented by the increase of the wall-to-lumen ratio (WLR) index. Abatacept (ABA), a T-cell co-stimulator blocker, is used to treat RA. A CV protective action was hypothesized for its peculiar mechanism of action in the modulation of T-cells, potentially involved in the pathogenesis of CV comorbidity. The study aimed to non-invasively investigate morphological characteristics of retinal arterioles in a cohort of RA patients treated with ABA.Materials and methodsSeventeen RA patients [median (25th-75thpercentile) age = 58 (48–64) years, baseline 28-joint Disease Activity Score DAS28-C-reactive protein (DAS28-CRP) = 4.4 (3.9–4.6), body mass index (BMI) = 24.2 (23.4–26) kg/m2, rheumatoid factor positive:52.9%, anti-citrullinated peptide autoantibodies positive:76.5%] without known CV risk factors (arterial hypertension, diabetes, hypercholesterolemia, previous CV events, smoking) were evaluated by the adaptive optics imaging system of retinal arterioles before and every 6 months of therapy with ABA (T0, T6 and T12). Office blood pressure evaluation, 24-h ambulatory blood pressure monitoring and tissue-doppler echocardiography were also performed.ResultsA progressive significant reduction of the WLR of retinal arterioles was observed [T0 = 0.28 (0.25–0.30), T6 = 0.27 (0.24–0.31), T12 = 0.23 (0.23–0.26); p T0 vs. T6 = 0.414; p T6 vs. T12 = 0.02; p T0 vs. T12 = 0.009], without significant variations in other parameters. The T0-T12 reduction of WLR was correlated with that of DAS28-CRP (r:0.789; p = 0.005). Moreover, a significant reduction of diastolic office blood pressure and a trend for reduction of daily pressure measured by ambulatory monitoring were observed.ConclusionIn a cohort of RA patients without known CV risk factors, a reduction of retinal microvascular alterations was demonstrated after treatment for 12 months with ABA, in parallel with the reduction of disease activity. These results might suggest the possibility of microvascular abnormalities regression induced by the immune system modulation. |
| first_indexed | 2024-03-08T02:02:34Z |
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| id | doaj.art-3a4ffd9b1ddc492fb3f2d2024efe1f02 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-03-08T02:02:34Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-3a4ffd9b1ddc492fb3f2d2024efe1f022024-02-14T04:16:33ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2024-02-011110.3389/fmed.2024.12470241247024Retinal microvascular alterations in patients with active rheumatoid arthritis without cardiovascular risk factors: the potential effects of T cell co-stimulation blockadeSilvia Piantoni0Francesca Regola1Fabrizio Angeli2Alessia Caproli3Annalisa Trovati4Cesare Tomasi5Giulia Chiarini6Claudia Rossini7Claudia Agabiti Rosei8Carolina De Ciuceis9Franco Franceschini10Maria Lorenza Muiesan11Damiano Rizzoni12Paolo Airò13Rheumatology and Clinical immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyInternal Medicine Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyInternal Medicine Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyInternal Medicine Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyInternal Medicine Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyInternal Medicine Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyInternal Medicine Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyBackgroundThe evaluation of microvascular alterations might provide clinically useful information for patients with an increased cardiovascular (CV) risk, such as those with rheumatoid arthritis (RA), being the small artery remodeling the earliest form of target organ damage in primary CV diseases, such as arterial hypertension. The evaluation of retinal arterioles is a non-invasive technique aimed to identify an early microvascular damage, represented by the increase of the wall-to-lumen ratio (WLR) index. Abatacept (ABA), a T-cell co-stimulator blocker, is used to treat RA. A CV protective action was hypothesized for its peculiar mechanism of action in the modulation of T-cells, potentially involved in the pathogenesis of CV comorbidity. The study aimed to non-invasively investigate morphological characteristics of retinal arterioles in a cohort of RA patients treated with ABA.Materials and methodsSeventeen RA patients [median (25th-75thpercentile) age = 58 (48–64) years, baseline 28-joint Disease Activity Score DAS28-C-reactive protein (DAS28-CRP) = 4.4 (3.9–4.6), body mass index (BMI) = 24.2 (23.4–26) kg/m2, rheumatoid factor positive:52.9%, anti-citrullinated peptide autoantibodies positive:76.5%] without known CV risk factors (arterial hypertension, diabetes, hypercholesterolemia, previous CV events, smoking) were evaluated by the adaptive optics imaging system of retinal arterioles before and every 6 months of therapy with ABA (T0, T6 and T12). Office blood pressure evaluation, 24-h ambulatory blood pressure monitoring and tissue-doppler echocardiography were also performed.ResultsA progressive significant reduction of the WLR of retinal arterioles was observed [T0 = 0.28 (0.25–0.30), T6 = 0.27 (0.24–0.31), T12 = 0.23 (0.23–0.26); p T0 vs. T6 = 0.414; p T6 vs. T12 = 0.02; p T0 vs. T12 = 0.009], without significant variations in other parameters. The T0-T12 reduction of WLR was correlated with that of DAS28-CRP (r:0.789; p = 0.005). Moreover, a significant reduction of diastolic office blood pressure and a trend for reduction of daily pressure measured by ambulatory monitoring were observed.ConclusionIn a cohort of RA patients without known CV risk factors, a reduction of retinal microvascular alterations was demonstrated after treatment for 12 months with ABA, in parallel with the reduction of disease activity. These results might suggest the possibility of microvascular abnormalities regression induced by the immune system modulation.https://www.frontiersin.org/articles/10.3389/fmed.2024.1247024/fullrheumatoid arthritisabataceptmicrocirculationcardiovascular riskinflammation |
| spellingShingle | Silvia Piantoni Francesca Regola Fabrizio Angeli Alessia Caproli Annalisa Trovati Cesare Tomasi Giulia Chiarini Claudia Rossini Claudia Agabiti Rosei Carolina De Ciuceis Franco Franceschini Maria Lorenza Muiesan Damiano Rizzoni Paolo Airò Retinal microvascular alterations in patients with active rheumatoid arthritis without cardiovascular risk factors: the potential effects of T cell co-stimulation blockade Frontiers in Medicine rheumatoid arthritis abatacept microcirculation cardiovascular risk inflammation |
| title | Retinal microvascular alterations in patients with active rheumatoid arthritis without cardiovascular risk factors: the potential effects of T cell co-stimulation blockade |
| title_full | Retinal microvascular alterations in patients with active rheumatoid arthritis without cardiovascular risk factors: the potential effects of T cell co-stimulation blockade |
| title_fullStr | Retinal microvascular alterations in patients with active rheumatoid arthritis without cardiovascular risk factors: the potential effects of T cell co-stimulation blockade |
| title_full_unstemmed | Retinal microvascular alterations in patients with active rheumatoid arthritis without cardiovascular risk factors: the potential effects of T cell co-stimulation blockade |
| title_short | Retinal microvascular alterations in patients with active rheumatoid arthritis without cardiovascular risk factors: the potential effects of T cell co-stimulation blockade |
| title_sort | retinal microvascular alterations in patients with active rheumatoid arthritis without cardiovascular risk factors the potential effects of t cell co stimulation blockade |
| topic | rheumatoid arthritis abatacept microcirculation cardiovascular risk inflammation |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2024.1247024/full |
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