Session Information
Title: Spondylarthropathies and Psoriatic Arthritis - Clinical Aspects and Treatment: Spondyloarthritis II
Session Type: Abstract Submissions (ACR)
Background/Purpose: Ankylosing spondylitis (AS) is associated with an increased cardiovascular (CV) risk that might be due to the chronic underlying inflammatory process. It is still unknown whether strong anti-inflammatory treatment with tumor-necrosis factor (TNF) inhibitors reduce the increased CV risk in AS. We investigated whether preclinical atherosclerosis and elasticity of the carotid arteries in patients with AS changed after use of TNF-inhibitors.
Methods: 67 out of 82 AS patients who underwent ultrasonography at baseline were measured again after 5 years. Assessments of medication use, AS related factors, CV risk factors and arterial parameters (including intima-media thickness (IMT) and Young’s elastic modulus (YEM)) were repeated at follow-up. Spearman’s rank correlation were used to investigate the correlation between changes in AS related factors or CV risk factors with changes in arterial wall parameters.
Results: After a mean follow-up of 5 years, 11 AS patients (16%) discontinued their use of TNF inhibitors. IMT did not change significantly (+0.012, p-value= 0.561) in those who continued the use of TNF inhibitors as compared to AS patients who discontinued use of TNF inhibitors (+0.060, p-value=0.025). Also, vascular elasticity (as measured with YEM) improved significantly in patients who continued TNF inhibitors (+0.031, p-value=0.002) but not in patients who discontinued TNF inhibitors. Correlations were found between 1. Unfavourable changes in BASDAI, BASG, BASMI and increase in IMT, and 2. Unfavourable changes in total cholesterol, LDL-cholesterol, total-HDL-cholesterol ratio and decrease in vascular elasticity (as measured with YEM).
Conclusion: Continuous use of TNF-inhibitors might stabilize or slow down IMT progression in AS patients, reflecting a decreased CV risk in these patients. Unfavourable changes in IMT were associated with equally unfavourable changes in AS related factors and unfavourable changes in vascular elasticity (as measured with YEM) were associated with unfavourable changes in lipid levels. The exact mechanism by which TNF inhibition modulates CV risk might be explained by different mechanisms (AS related factors and IMT vs. lipid levels and YEM).
Table 1. Correlations between changes in AS- and CV related factors and changes in arterial wall characteristics
|
|
Intima-media Thickness |
Young’s Elastic Modulus |
||
|
|
Correlation coefficient |
p-value |
Correlation coefficient |
p-value |
|
AS related factors |
|
|
|
|
|
BASDAI |
0.308 * |
0.013 |
-0.201 |
0.117 |
|
BASFI |
0.113 |
0.368 |
0.081 |
0.533 |
|
BASG |
0.311 * |
0.012 |
-0.167 |
0.195 |
|
BASMI |
0.327 * |
0.007 |
-0.062 |
0.632 |
|
ESR |
0.030 |
0.822 |
-0.085 |
0.533 |
|
CRP |
0.042 |
0.752 |
-0.114 |
0.401 |
|
CV risk factors |
|
|
|
|
|
Systolic blood pressure |
-0.075 |
0.559 |
-0.102 |
0.440 |
|
Diastolic blood pressure |
-0.109 |
0.395 |
-0.016 |
0.902 |
|
Pulse pressure |
0.002 |
0.986 |
-0.100 |
0.446 |
|
Body-mass index |
-0.084 |
0.516 |
0.005 |
0.968 |
|
Total cholesterol |
0.309 * |
0.042 |
-0.276 |
0.076 |
|
HDL-cholesterol |
0.081 |
0.612 |
0.137 |
0.401 |
|
LDL-cholesterol |
0.251 |
0.123 |
-0.277 |
0.097 |
|
Total- to HDL-cholesterol ratio |
0.117 |
0.462 |
-0.319 * |
0.045 |
* p < 0.05
Figure 1. Changes in IMT and BASMI, YEM and Total cholesterol to HDL-cholesterol ratio
Disclosure:
A. M. van Sijl,
None;
I. C. van Eijk,
None;
M. J. L. Peters,
None;
E. H. Serne,
None;
Y. M. Smulders,
None;
M. T. Nurmohamed,
None.
« Back to 2012 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/tumor-necrosis-factor-blocking-agents-inhibit-the-progression-of-preclinical-atherosclerosis-in-patients-with-ankylosing-spondylitis/