Review Article

Asymmetric Dimethyl Arginine as a Biomarker of Atherosclerosis in Rheumatoid Arthritis

Table 1

Main findings of the studies investigating ADMA in rheumatoid arthritis.

Number of RA patients (controls)Main findingsReference

91 (31)No correlation between ADMA and subendocardial viability ratioAnyfanti et al. [94]
201No association between ADMA and genetic variants of the AGXT2 geneDimitroulas et al. [95]
197Association between microvascular function, arterial stiffness, and cIMT and ADMA/SDMA levels in RA patients with high inflammatory markerDimitroulas et al. [85]
40 (29)Inverse correlation between ADMA and FMD; positive correlation between ADMA and disease duration; no correlation with CRPSentürk et al. [88]
30 (30)No relationship between ADMA concentration and aortic augmentation; no difference in ADMA levels between patients and controlsErre et al. [96]
201Difference in ADMA levels according to MTHFR; positive correlation between ADMA and Hcy and ESRDimitroulas et al. [92]
100No correlation between ADMA and thCys at baseline and after omega-3 fatty acids, vitamin E, vitamin A, copper, and selenium, or placebo; correlation between ADMA and arginineKayacelebi et al. [98]
201Positive correlation between ADMA and ESR and ADMA and CRPSandoo et al. [89]
33Correlation between ADMA and DAS28; reduction of ADMA levels after 3 months of anti-TNFSpinelli et al. [66]
201No significant relationship between DDAH genetic variables and ADMA levelsDimitroulas et al. [97]
17 (12)Inverse correlation between ADMA levels and circulating EPC numberSpinelli et al. [65]
35 (35)ADMA and RF have similar sensitivity and specificity in the detection of endothelial dysfunctionSpasovski and Sotirova [91]
67HOMA, an indicator of insulin resistance, predicts elevated ADMA levelsDimitroulas et al. [93]
48 (32)Association between baseline PWV and ADMA but no correlation with cIMT; anti-TNF therapy increased L-arginine/ADMA ratio but not ADMA after 3 monthsAngel et al. [84]
20 (20)Significantly higher ADMA levels in RA than controls; significant reduction after 12 months of treatmentDi Franco et al. [77]
35No change in ADMA levels after 2 weeks and 3 months of anti-TNF treatmentSandoo et al. [75]
46 (50)Higher ADMA levels in RA than in controls; correlation with CRP, DAS28, and 8-isoprostanesKwaśny-Krochin et al. [86]
60 (29)Significantly higher ADMA levels in RA compared with controls; no correlation with demographic or disease characteristicsSandoo et al. [83]
25No change in ADMA levels and cIMT after treatmentTuriel et al. [82]
25 (25)Higher ADMA levels in early RA than in controls. Significant negative correlation between ADMA levels and CFR; no correlation with IMTTuriel et al. [90]
20Positive correlation between ACPA and ADMA levels; no correlation with disease activity indicesSurdacki et al. [87]
36 (20)Chronic low-dose prednisolone lower ADMA levelsRadhakutty et al. [109]

ADMA = asymmetric dimethyl arginine; AGXT2 = alanine-glyoxylate aminotransferase 2; SDMA = symmetric dimethyl arginine; cIMT = carotid intima media thickness; FMD = flow-mediated dilation; CRP = C-reactive protein; MTHFR = methylenetetrahydrofolate reductase; Hcy = homocysteine; ESR = erythrocyte sedimentation rate; thCys = total L-homocysteine; DAS28 = disease activity score 28; TNF = tumor necrosis factor; DDAH = dimethylaminohydrolase; EPCs = endothelial progenitor cells; RF = rheumatoid factor; HOMA = homeostasis model assessment; PWV = pulse wave velocity; CFR = coronary flow reserve; ACPA = anticitrullinated peptide antibodies.