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document
The peroxisome proliferator activated receptor-γ pioglitazone improves vascular function and decreases disease activity in patients with rheumatoid arthritis . BACKGROUND Rheumatoid arthritis ( RA ) is associated with heightened mortality due to atherosclerotic cardiovascular disease ( CVD ) . Inflammatory pathways in RA negatively affect vascular physiology and promote metabolic disturbances that contribute to CVD . We hypothesized that the peroxisome proliferator activated receptor-γ ( PPAR-γ ) pioglitazone could promote potent vasculoprotective and anti-inflammatory effects in RA . METHODS AND RESULTS One hundred forty-three non-diabetic adult RA patients ( 76.2 % female , age 55.2 ± 12.1 [ mean ± SD ] ) on stable RA standard of care treatment were enrolled in a randomized , double-blind placebo controlled crossover trial of 45 mg daily pioglitazone versus placebo , with a 3-month duration/arm and a 2-month washout period . Pulse wave velocity of the aorta ( PWV ) , brachial artery flow mediated dilatation ( FMD ) , nitroglycerin mediated dilatation ( NMD ) , microvascular endothelial function ( reactive hyperemia index [ RHI ] ) , and circulating biomarkers of inflammation , insulin resistance , and atherosclerosis risk all were quantified . RA disease activity was assessed with the 28-Joint Count Disease Activity Score ( DAS-28 ) C-reactive protein ( CRP ) and the Short Form ( 36 ) Health Survey quality of life questionnaire . When added to standard of care RA treatment , pioglitazone significantly decreased pulse wave velocity ( ie , aortic stiffness ) ( P=0.01 ) , while FMD and RHI remained unchanged when compared to treatment with placebo . Further , pioglitazone significantly reduced RA disease activity ( P=0.02 ) and CRP levels ( P=0.001 ) , while improving lipid profiles . The drug was well tolerated . CONCLUSIONS Addition of pioglitazone to RA standard of care significantly improves aortic elasticity and decreases inflammation and disease activity with minimal safety issues . The clinical implications of these findings remain to be established . CLINICAL TRIAL REGISTRATION URL ClinicalTrials.gov Unique Identifier : NCT00554853 .
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Intervention_Pharmacological
receptor-γ pioglitazone
62471
Intervention_Pharmacological
( PPAR-γ ) pioglitazone
62472
Intervention_Pharmacological
pioglitazone
62473
Intervention_Pharmacological
pioglitazone
62474
Intervention_Pharmacological
pioglitazone