Background/Purpose: Cardiovascular (CV) disease and osteoporosis (OP) have become increasing challenges in the ageing population, even more in patients with inflammatory rheumatic diseases, such as rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Both diseases have been associated with generalized and localized bone loss, accelerated atherosclerosis, increased CV morbidity and mortality. 

Bone and vascular biomarkers and parameters along with the effect of one-year anti-TNF therapy on these markers were assessed in order to determine correlations between vascular pathophysiology and bone metabolism in RA and AS.

Methods: Fifty-three patients including 36 RA patients treated with etanercept (ETN) or certolizumab pegol (CZP) and 17 AS patients treated with ETN were included in a 12-month follow-up study. Bone and vascular markers were assessed by ELISA. Bone density was measured by DXA and quantitative CT (QCT). Flow-mediated vasodilation (FMD), common carotid intima-media thickness (IMT) and pulse-wave velocity (PWV) were assessed by ultrasound. Data on the effects of vascular markers on bone and bone effects on vasculature had undergone statistical analysis.

Results: We found a great number of correlations between vascular and bone surrogate markers. Both univariable and multivariable analyses suggested that osteoprotegerin (OPG) may positively determine FMD, parathyroid hormone (PTH) may be a determinant of PWV and sclerostin (SOST) may influence IMT at different time points. QCT total and trabecular BMD inversely correlated with IMT and IMT was also inversely associated with QCT total BMD. Baseline vitamin D3 (VITD3) inversely affected PWV. Some biomarkers at baseline also significantly determined other parameters at later time points. Moreover, one-year biologic treatment combined with baseline levels of different bone biomarkers may predict changes of IMT upon therapy. According to the multivariate analyses, systemic inflammation (C-reactive protein) or disease activity, as well as their change between baseline and 12 months may significantly influence the interrelationship between certain bone and vascular biomarkers.

Conclusion: In our study of anti-TNF treated RA and AS patients, vascular and bone parameters showed numerous correlations. Some bone markers may predict vascular status after one-year treatment and vice versa. Systemic inflammation and arthritic disease activity may influence the associations between bone and vascular biomarkers.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/associations-of-vascular-and-bone-status-in-anti-tnf-treated-rheumatoid-arthritis-and-ankylosing-spondylitis-patients/