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Abstract Number: 494

Arterial Wall Inflammation Declines after 6 Months of Anti-Inflammatory Therapy with Methotrexate and/or Adalimumab in Rheumatoid Arthritis Patients

Annelies Blanken1, Rabia Agca1, Alexandre Voskuyl2, Ronald Boellaard3, Conny van der Laken2 and Michael Nurmohamed2,4, 1Amsterdam Rheumatology and immunology Center, Location Reade, Amsterdam, Netherlands, 2Amsterdam Rheumatology and immunology Center, Location VU University Medical Center, Amsterdam, Netherlands, 3Radiology and Nuclear Medicine, Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands, 4Rheumatology, Amsterdam Rheumatology and immunology Center, Location Reade, Amsterdam, Netherlands

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: 18FDG PET/CT scan, Arteriosclerosis, Cardiovascular disease, Comorbidity and rheumatoid arthritis (RA)

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Session Information

Date: Sunday, October 21, 2018

Session Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster I: Comorbidities

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Patients with rheumatoid arthritis (RA) have an elevated cardiovascular (CV) disease risk, mostly explained by both an increased prevalence of traditional CV risk factors and the presence of systemic inflammation that accelerates atherosclerosis. There is accumulating evidence that anti-inflammatory treatment for RA reduces this CV risk. A non-invasive tool for detecting arterial wall inflammation in atherosclerosis is 18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography (18F-FDG-PET/CT). In this study we investigated the effect of anti-inflammatory treatment with methotrexate (MTX) and/or adalimumab on arterial wall inflammation in RA assessed by 18F-FDG-PET/CT.

Methods:

18F-FDG-PET/CT was done in patients with active early RA starting MTX (n=25) and active established RA starting adalimumab (n=24) before and after 6 months of therapy, and in osteoarthritis controls (OA; n=29). 18F-FDG uptake in arterial wall was determined by standardized uptake values (SUV). Volumes of interest covering the arterial segment with the highest 18F-FDG were defined to derive the maximum SUV (SUVmax) in the ascending, descending and abdominal aorta and the aortic arch. Global arterial uptake was estimated using the mean SUVmax of the  arterial segments.

Results:

Mean age was 65±9 for early RA, 61±7 for established RA and 63±5 years for OA controls. Median disease duration was 2.1 (interquartile range (IQR) 1.3-3.3) weeks for early RA and 6.9 (IQR 1.8-13.9) years for established RA. DAS28 was 4.9±1.0 and 4.4±1.0 at baseline and declined to 3.1±1.3 and 2.8±1.4 after 6 months therapy, respectively.

At baseline mean SUVmax was 1.86±0.38 for early RA, 1.68±0.43 for established RA and 1.56±0.41 for OA controls. SUVmax tended  to decline more in early RA patients when compared to established RA (1.86±0.38 to 1.79±0.43 (-3.7%) and 1.68±0.43 to 1.63±0.43 (-3.0%), respectively). SUVmax in most arterial segments declined after 6 months of therapy (Table 1). The most prominent decline in SUVmax was in de abdominal aorta in established RA patients (-9.8%).

Conclusion:

A decline in global arterial SUVmax and in most of arterial segments was found in both early and established RA patients after 6 months of MTX and/or adalimumab, suggesting that anti-inflammatory therapy with either MTX and/or adalimumab decreases arterial wall inflammation and thus CV risk in RA.

Table 1. Arterial 18F-FDG uptake

 

OA

Early RA

Established RA

Baseline

Baseline

6 months MTX

Δ

Baseline

6 months adalimumab

Δ

SUVmax
ascending aorta

1.55±0.44

1.82±0.38

1.77±0.38

-2.7%

1.69±0.61

1.60±0.44

-5.3%

SUVmax descending aorta

1.57±0.42

1.93±0.53

1.81±0.47

-6.2%

1.65±0.39

1.71±0.47

+3.6%

SUVmax
abdominal aorta

1.62±0.43

1.84±0.44

1.81±0.58

-1.6%

1.73±0.61

1.56±0.45

-9.8%

SUVmax
aortic arch

1.51±0.48

1.85±0.48

1.76±0.45

-4.9%

1.66±0.40

1.64±0.59

-1.2%

Mean SUVmax over 4 segments

1.56±0.42

1.86±0.38

1.79±0.43

-3.7%

1.68±0.43

1.63±0.43

-3.0%

 


Disclosure: A. Blanken, None; R. Agca, None; A. Voskuyl, None; R. Boellaard, None; C. van der Laken, None; M. Nurmohamed, AbbVie, Pfizer, Merck, Roche, BMS, UCB, Eli Lilly, Celgene and Janssen, 2, 5, 8.

To cite this abstract in AMA style:

Blanken A, Agca R, Voskuyl A, Boellaard R, van der Laken C, Nurmohamed M. Arterial Wall Inflammation Declines after 6 Months of Anti-Inflammatory Therapy with Methotrexate and/or Adalimumab in Rheumatoid Arthritis Patients [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/arterial-wall-inflammation-declines-after-6-months-of-anti-inflammatory-therapy-with-methotrexate-and-or-adalimumab-in-rheumatoid-arthritis-patients/. Accessed January 17, 2021.
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