Conversion towards an atherogenic lipid profile in rheumatoid arthritis patients during long-term infliximab therapy

Objectives: To analyse the effects of infliximab infusions on serum levels of lipids in patients with rheumatoid arthritis ( RA) treated for 2 years. Methods: Fifty-two patients ( 41 females and 11 males) with RA undergoing infliximab treatment ( 3 mg/kg) were consecutively recruited into the study. The mean ( +/- SD) age of the patients was 54.6 +/- 12.5 years and mean disease duration was 14.1 +/- 8.6 years. Blood was sampled before infusion at baseline, and at 3, 6, 12, 18 and 24 months. Forty-one of the patients were also treated with methotrexate, 13 with other disease-modifying antirheumatic drugs ( DMARDs) and 28 with prednisolone ( < 10 mg daily). For comparison, lipid levels were followed for 2 years in 70 consecutively included patients with early RA during treatment with conventional DMARDs. Results: There was an initial increase in plasma levels of cholesterol, high density lipoprotein ( HDL)-cholesterol, low density lipoprotein ( LDL)-cholesterol, and LDL/HDL and total/HDL cholesterol ratios. However, after 3 months HDL-cholesterol decreased significantly, followed after 6 months by cholesterol and LDL-cholesterol. The LDL/HDL and total/HDL-cholesterol ratios remained significantly raised. HDL-cholesterol increased and the ratios improved in patients with early RA receiving conventional treatment. The changes over time differed significantly between the patient groups. Conclusion: During infliximab infusion a pro-atherogenic lipid profile developed despite reduced inflammatory activity. The long-term decrease in HDL-cholesterol was unexpected considering the known effects of tumour necrosis factor-alpha ( TNF alpha).