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Systemic disease and the heart
Lowering interleukin-1 activity with anakinra improves myocardial deformation in rheumatoid arthritis
  1. I Ikonomidis1,
  2. S Tzortzis1,
  3. J Lekakis1,
  4. I Paraskevaidis1,
  5. I Andreadou2,
  6. M Nikolaou1,
  7. T Kaplanoglou3,
  8. P Katsimbri3,
  9. G Skarantavos3,
  10. P Soucacos3,
  11. D Th Kremastinos1
  1. 1
    2nd Cardiology Department, Attikon Hospital, University of Athens, Greece
  2. 2
    Department of Pharmaceutical Chemistry, University of Athens School of Pharmacy, Athens, Greece
  3. 3
    1st Department of Orthopaedics, Attikon Hospital, University of Athens, Greece
  1. Correspondence to Dr Ignatios Ikonomidis, University of Athens, Perikleous 19, N Chalkidona, Athens, 14343, Greece; ignoik{at}


Objective: Inhibition of interleukin-1 activity improves nitro-oxidative stress, endothelial and coronary function. The authors investigated (a) the association of nitro-oxidative stress and endothelial function with myocardial deformation, (b) the effects of anakinra, an interleukin-1a receptor antagonist on myocardial deformation in patients with rheumatoid arthritis (RA).

Methods: The authors compared 46 RA patients to 23 normal controls. 23 patients received anakinra (150 mg subcutaneously once daily) and 23 patients a 5-mg increase of prednisolone dose for 30 days. At baseline and post-treatment this study assessed (a) the left ventricular (LV) longitudinal, circumferential and radial strain and strain rate, using speckle tracking echocardiography, (b) the coronary flow reserve (CFR), (c) the flow-mediated endothelial-dependent dilation of the brachial artery (FMD) and (d) nitrotyrosine (NT) and malondialdehyde blood levels.

Results: Patients had impaired baseline myocardial deformation indices compared to controls (p<0.05). CFR and NT levels were related to longitudinal strain, systolic and diastolic strain rate, circumferential strain and systolic strain rate (p<0.05). FMD was related to longitudinal and circumferential diastolic strain rate (p<0.01). Compared to baseline, anakinra-treated patients increased the longitudinal strain (−17.8% (3.7%) vs −22.1% (3.5%)), systolic (−1.02 (0.23) l/s vs −1.25 (0.23) l/s) and diastolic (0.96 (0.37) l/s vs 1.20 (0.39) l/s) longitudinal strain rate, circumferential strain and strain rate (p<0.05 for all comparisons). No significant changes were observed among prednisolone-treated patients

Conclusions: Myocardial deformation is impaired in RA patients and is related to nitro-oxidative stress and endothelial dysfunction. Chronic inhibition of IL-1 improves LV deformation in parallel with endothelial function and nitro-oxidative stress.

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • See Editorial, p 1471

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