Methotrexate and Anti-Tumor Necrosis Treatment Improve Endothelial Function in Patients with Rheumatoid Arthritis, Psoriatic Arthritis and Ankylosing Spondylitis

Gia Deyab¹, Ingrid Hokstad², Stefan Agewall³, Torstein Lyberg⁴, Jon Elling Whist⁵, Milada Cvancarova Småstuen⁶, Gunnbjørg Hjeltnes⁷ and Ivana Hollan^8,9,10,11, ¹Department of Medical Biochemistry, Innlandet Hospital Trust, Lillehammer, Norway, ²Lillehammer Hospitat for Rheumatic Diseases, Lillehammer, Norway, ³University of Oslo, Oslo, Norway, ⁴Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway, ⁵Innlandet Hospital Trust, Lillehammer, Norway, ⁶Institution of health care - Health science PhD program, Oslo and Akershus University College, Oslo, Norway, ⁷Medicine, Innlandet Hospital Trust, Lillehammer, Norway, ⁸Harvard Medical School, Boston, MA, ⁹Department of Medicine, Brigham and Women's Hospital, Boston, MA, ¹⁰Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway, ¹¹Innlandet Hospital Trust, Brumunddal, Norway

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Ankylosing spondylitis (AS), Atherosclerosis, Psoriatic arthritis, rheumatoid arthritis (RA) and treatment

Session Information

Date: Monday, November 14, 2016

Title: Spondylarthropathies Psoriatic Arthritis – Pathogenesis, Etiology - Poster I

Session Type: ACR Poster Session B

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

Background/Purpose: Inflammatory rheumatic diseases (IRDs) are associated with accelerated atherosclerosis, which progression is related to inflammation (1). One of the first stages in atherogenesis is endothelial dysfunction (ED). Therefore, we aimed to examine the effects of methotrexate (MTX) and anti-tumor necrosis factor (anti-TNF) treatment (with or without MTX co-medication) on endothelial function (EF) in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS).

Methods: From the data registry from PSARA (2) (an observational study), we evaluated patients with RA (n=64), PsA (n=30) and AS (n=20) who completed a 6 month follow-up after initiation of anti-rheumatic therapy due to active disease. Only patients with clinical indication of either MTX monotherapy or anti-TNF with or without MTX co-medication (anti-TNF±MTX) were included. Among patients with peripheral arthritis (i.e., all RA and PsA patients), all patients starting on anti-TNF therapy had been previously unsuccessfully treated with MTX, while in patients with axial affection only (i.e., all AS), anti-TNF could be used as the first as well as later disease modifying anti-rheumatic treatment. EF was assessed by finger plethysmography (RH-PAT): Reactive hyperemia index (RHI) <1.67 was considered as ED. In patients with ED at baseline (n=39), we searched for change in EF after 6 weeks and 6 months of anti-rheumatic therapy.

Results: In all IRD patients with ED, RHI improved from baseline to 6 weeks (mean change=0.56, p<0.005) and 6 months (mean change=0.46, p<0.005). RHI improved at 6 weeks and 6 months in all three diagnoses, but the differences were statistically significant only for RA at 6 weeks and 6 months, and for PsA at 6weeks, with the greatest improvements in RA. The effect of MTX and anti-TNF±MTX at 6 weeks was similar. However, at 6 months, RHI improved more in the MTX group than in the anti-TNF±MTX group (mean change 0.74 vs. 0.24; p=0.010), and this difference remained statistically significant after adjustments for potential confounders including traditional cardiovascular risk factors and markers of disease activity.

Conclusion: Treatment with MTX and anti-TNF±MTX appears to relatively fast improve EF in IRD patients with ED, independently of improvement in disease activity. After 6 months, the EF improvement was more pronounced in the MTX users than in the anti TNF±MTX users. Among other factors, this might be due to a better effect of MTX on the vasculature, or due to different patient populations. For example, RA and SpA patients starting with anti-TNF were more likely to have a longer and therapy resistant disease than patients starting with MTX.

Disclosure: G. Deyab, None; I. Hokstad, None; S. Agewall, None; T. Lyberg, None; J. E. Whist, None; M. Cvancarova Småstuen, None; G. Hjeltnes, None; I. Hollan, None.

To cite this abstract in AMA style:

Deyab G, Hokstad I, Agewall S, Lyberg T, Whist JE, Cvancarova Småstuen M, Hjeltnes G, Hollan I. Methotrexate and Anti-Tumor Necrosis Treatment Improve Endothelial Function in Patients with Rheumatoid Arthritis, Psoriatic Arthritis and Ankylosing Spondylitis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/methotrexate-and-anti-tumor-necrosis-treatment-improve-endothelial-function-in-patients-with-rheumatoid-arthritis-psoriatic-arthritis-and-ankylosing-spondylitis/. Accessed .

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