Background/Purpose: Patients with rheumatoid arthritis (RA) have an increased cardiovascular (CV) risk. We should have strategies for primary cardiovascular　prevention in RA. We reported Tofacitinib(Tofa) plus methotrexate improve arterial stiffness in RA. How about Tofa monotherapy. To examine the effect of Tofa monotherapy on arterial stiffness with CV disease in conventional DMARDs resistant RA patients in a cohort study design.

Methods: 16 RA patients with moderate to severe active disease despite conventional DMARDs treatment (disease activity score: DAS28>3.2) were received Tofa monotherapy. Arterial stiffness was assessed with cardio-ankle vascular index (CAVI) and augmentation index corrected for a heart rate of 75 beats per minute (AIx@75) at baseline and 24 weeks follow-up. Clinical data were collected at regular visits. CAVI is very similar to pulse wave velocity (PWV), and CAVI measures arterial wall stiffness independent of blood pressure and it is superior to brachial ankle PWV as an index of arterial stiffness.No new all treatments(statin, low lipids drug, and etc.) were allowed.

Results:  Treatment with Tofa monotherapy attenuated the CAVI significantly from baseline to 24 weeks follow up(13.62 ± 1.96 and 11.44± 1.65%; p = 0.021). Treatment with Tofa monotherapy attenuated the Aix@75 significantly from baseline to 24 weeks follow up(38.7 ± 11.6, 35.2 ± 8.6 %; p = 0.024). DAS 28-ESR score improved significantly from baseline to 24 weeks(5.56±1.29, 2.61±1.45: p=0.01). On the other hand, fasting serum total cholesterol TC was significantly increased from baseline to follow-up at 24 weeks (187±28.2mg/dL, 209±19.8mg/dL, p = 0.021). No patients suffered from new CV disease.

Conclusion: These findings suggest that Tofa monotherapy not only reduced RA disease activity but also limited vascular damage despite up-regulating cholesterol in patients conventional DMARDs resistant active RA, as well as Tofa plus methotrexate.

References:Kume K. et al. Tofacitinib improves arterial stiffness with methotrexate-resistant active rheumatoid arthritis. A cohort study. 10.1136/annrheumdis-2014-eular.1019

Takaki A et al. Cardio-ankle vascular index is superior to brachial-ankle pulse wave velocity as an index of arterial stiffness. Hypertens Res.2008 Jul; 31(7):1347-55

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/tofacitinib-monotherapy-improves-arterial-stiffness-in-conventional-dmards-active-rheumatoid-arthritis-patients-a-cohort-study/