Background/Purpose: The cause of the increased cardiovascular risk in inflammatory rheumatic diseases (IRDs) is still unclear. Intriguingly, selenium-deficiency, which might be caused by poor diet or inflammation, has been proposed to contribute to development of cardiovascular disease (CVD), and selenium supplementation has been reported to decrease CV risk. Moreover, decreased selenium-levels are likely to promote inflammation.

The aim of this study was to compare serum selenium (s-Se) levels in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS), and to evaluate if these levels are influenced by methotrexate (MTX) and/or anti-tumor necrosis factor treatment (anti-TNF). Furthermore, to assess if s-Se levels are associated with markers of disease activity and endothelial function (EF).

Methods:

From the biobank of PSARA study, we examined samples from 131 IRD patients starting with either MTX or anti-TNF with or without MTX (anti-TNF±MTX) due to high active disease. s-Se (atomic absorption spectroscopy), EF (finger plethysmography) and serologic inflammatory biomarkers were evaluated at baseline and after 6 weeks and 6 months of therapy.

Results: The baseline median s-Se levels in the total IRD group (72µg/L) were within the reference range 50-120 µg/L. The s-Se levels increased in all groups after 6 weeks and 6 months of therapy, but the differences from baseline were not statistically significant. Changes in s-Se were significantly related to changes in CRP and ESR (both p=0.001 at 6 weeks and p=0.033 and p=0.035 at 6 months, respectively), but not to changes in EF. There were no statistically significant differences neither in s-Se baseline levels nor in changes in s-Se between baseline and follow up between RA , AS and PsA . In patients treated with MTX, s-Se levels increased after 6 weeks (p=0.012) and 6 months of therapy (p=0.038). In patients treated with anti-TNF±MTX, there were no changes in s-Se levels during the follow-up.

Conclusion: IRD patients had s-Se levels within the normal range. The s-Se levels increased after 6 weeks and 6 months of anti-rheumatic therapy, but the differences were statistically significant only in patients treated with MTX monotherapy (not in those treated with anti-TNF). Thus, larger and longer studies are needed to determine if anti-rheumatic treatment, in particular MTX, might influence CV risk through increasing s-Se levels (either due to its anti-inflammatory effect or other effects).

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-anti-rheumatic-treatment-on-selenium-levels-in-rheumatoid-arthritis-psoriatic-arthritis-and-ankylosing-spondylitis/