Background/Purpose:  Psoriatic Arthritis (PsA) is associated with increased morbility and mortality and an accelerated atherosclerosis. Influence of anti-TNFalpha treatment (a widely used therapy in PsA) in subclinical atherosclerosis is still unclear. The aim of this study was to evaluate subclinical atherosclerosis progression before and after 5 years of anti-TNFalpha treatment.

Methods:  Twenty-seven consecutive PsA patients were evaluated before TNF blockers therapy (T0), after 2 years (T1) and after 5 years (T2) of treatment. Subclinical atherosclerosis was evaluated through carotid duplex scanning, analyzing intima-media thickness (IMT) and flow-mediated dilation (FMD). IMT values were expressed as IMT mean (cumulative mean of all the IMT mean in every analyzed carotid segment) and M-MAX (cumulative mean of all the higher IMT in every analyzed carotid segment). Response to therapy was studied by the evaluation of tender and swollen joints (Tj and Sj), DAS 28 (disease activity score), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Metrologic and metabolic data were collected. For the statistical evaluation of parameters over time (T0 vs T1, T1 vs T2) Student’s T test for paired data was used.

Results:  From T0 to T1 there was a significant deterioration in both IMT-mean and M-MAX (0.72±0.15 vs 0.91±0.37 and 0.89±0.18 vs 1.06±0.39 respectively, p<0.01). At T2 IMT-mean did not change significantly (0.91±0.37 vs 0.92± 0,34, p=ns), while M-MAX worsened further (1.06±0.39 vs 1.10±0.35, p<0.05). No significant variation in FMD values was observed during the 5 year follow up (T0 vs T1: 5.40±1.93 vs 5.37±1.66, p=ns; T1 vs T0: 5.37±1,66 vs 5.40±1.89, p=ns). Noteworthy, systolic blood pressure and Body Mass Index remained stable from T0 to T2 (132.03± 19.67 vs 132.32± 13.46, p=ns, and 26.33±4.03 vs 25.96±3.41, p=ns), while diastolic blood pressure decreased (79,57±8,73 vs 74.40±6.83, p=0,001). A good response to treatment was evident already at T1, with a significant decrease of: Tj (8.10±5.56 vs 2.09±2.32, p<0.01), Sj (3.85±3.84 vs 0.25±0.72, p<0.01), DAS 28 (4,16±0.67 vs 2.30±0.82, p<0.01) and CRP (11.25±9.16 vs 2.91±1.72, p<0.01). The efficacy was preserved from T1 to T2 in terms of Tj (2.09±2.32 vs 1.72± 2.05, p=ns), Sj (0.25±0.72 vs 0.50±0.92, p=ns), DAS 28 (2.30±0.82 vs 2.40±0,9, p=ns), CRP (2.91±1.72 vs 2.73 ±2.51, p=ns).

Conclusion:  Our data revealed that in patients with PsA, despite treatment with TNF blockers, there is still a gradual, albeit slight progression of subclinical atherosclerosis assessed by ultrasonography. Other inflammatory mechanisms not related to TNF may be responsible of the progression in atherosclerotic disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/subclinical-atherosclerosis-evolution-during-5-years-of-anti-tnfalpha-treatment-in-psoriatic-arthritis-patients-preliminary-data/