Document Detail


A signature of aberrant immune responsiveness identifies myocardial dysfunction in rheumatoid arthritis.
MedLine Citation:
PMID:  21384332     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Heart failure is an important cause of death in patients with rheumatoid arthritis (RA). Evidence suggests that immune mechanisms contribute to myocardial injury and fibrosis, leading to left ventricular diastolic dysfunction (LVDD). The purpose of this study was to identify a signature of LVDD in patients with RA by analyzing the responsiveness of the innate and adaptive immune systems to stimulation ex vivo.
METHODS: RA patients (n=212) enrolled prospectively in a population-based cohort underwent echocardiography, and LV function was classified as normal, mild LVDD, or moderate-to-severe LVDD. The release of 17 cytokines by blood mononuclear cells in response to stimulation with a panel of 7 stimuli or in media alone was analyzed using multiplex immunoassays. Logistic regression models were used to test for associations between a multicytokine immune response score and LVDD, after adjusting for clinical covariates.
RESULTS: An 11-cytokine profile effectively differentiated patients with moderate-to-severe LVDD from those with normal LV function. An immune response score (range 0-100) was strongly associated with moderate-to-severe LVDD (odds ratio per 10 units 1.5 [95% confidence interval 1.2-2.1]) after adjusting for serum interleukin-6 levels, brain natriuretic peptide values, and glucocorticoid use, as well as other RA characteristics and LVDD risk factors.
CONCLUSION: The major finding of this study was that aberrant systemic immune responsiveness is associated with advanced myocardial dysfunction in patients with RA. The unique information added by the immune response score concerning the likelihood of LVDD warrants future longitudinal studies of its value in predicting future deterioration in myocardial function.
Authors:
John M Davis; Keith L Knutson; Michael A Strausbauch; Cynthia S Crowson; Terry M Therneau; Peter J Wettstein; Veronique L Roger; Eric L Matteson; Sherine E Gabriel
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  63     ISSN:  1529-0131     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-06-01     Completed Date:  2011-08-17     Revised Date:  2012-04-23    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1497-506     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 by the American College of Rheumatology.
Affiliation:
Mayo Clinic, Rochester, Minnesota 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Antirheumatic Agents / therapeutic use
Arthritis, Rheumatoid / complications,  drug therapy,  immunology*
Cytokines / blood,  immunology
Female
Humans
Male
Middle Aged
Prospective Studies
Severity of Illness Index
Ventricular Dysfunction, Left / etiology,  immunology*,  ultrasonography
Grant Support
ID/Acronym/Agency:
1-KL2-RR-024151/RR/NCRR NIH HHS; 1-UL1-RR-024150/RR/NCRR NIH HHS; KL2 RR024151-06/RR/NCRR NIH HHS; R01 AG034676/AG/NIA NIH HHS; R01 AG034676-46/AG/NIA NIH HHS; R01 AR046849-10/AR/NIAMS NIH HHS; R01-R-46849//PHS HHS; UL1 RR024150-05/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Antirheumatic Agents; 0/Cytokines

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