Specific Aims
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Aim 1: To compare the effects on vascular inflammation of two commonly prescribed therapies in patients with RA who do not have improved RA symptoms when taking methotrexate alone. We hope to show that TNF inhibitors, such as Enbrel and Humira, will reduce cardiac inflammation to a greater extent than triple therapy will after 6 months. Both treatments have recently been shown to be equally as effective in reducing pain, improving patient function, and curbing the severity and frequency of RA symptoms. For now, it remains unclear whether the quicker relief of joint inflammation by TNF antagonists would translate into a greater reduction of vascular inflammation.
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Aim 2:To compare vascular inflammation in subjects who do and do not achieve remission after six months on their new therapies. We hope to show that subjects in disease remission will have less vascular inflammation than those who do not reach remission.
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Aim 3:To compare the effects of the alternative treatments on joint inflammation. We hope to show that joint inflammation will be more reduced in subjects using Enbrel or Humira and taking methotrexate as compared to those on triple therapy. While patients on these therapies feel the same, we wonder whether imaging will reveal that their joints have different levels of inflammation.
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Aim 4:To examine the relationship between certain compounds in a patient's blood and vascular inflammation. These compounds, known as biomarkers, can now be used to identify a patient's risk of Cardiovascular disease and severity of RA symptoms. These biomarkers include IL-6, CRP, serum amyloid protein, fibrinogen, ICAM-1, and Vecta DA, a multi-marker indicator of systemic inflammation in RA. Data from this trial will be used to inspire and carry out future studies.
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