Background/Purpose: Psoriatic arthritis (PsA) patients have increased cardiovascular morbidity and mortality. Altered lipid profile is an important risk factor for the development of these complications. There are, however, no data regarding prospective long-term evaluation of lipid profile in PsA patients under TNF blockers. The purpose of this study is to evaluate prospectively the long-term effect of anti-TNF therapy on lipid profile in PsA patients

Methods: Thirty-two consecutive PsA patients, who were eligible to receive anti-TNF therapy, were prospectively enrolled. All patients were treated with TNF blockers, and they were evaluated for lipid profile, atherogenic index (AI), body mass index (BMI), waist circumference and disease parameters at baseline and at 104 weeks after treatment. Lipoprotein risk level for coronary heart disease (CHD) were defined by National Cholesterol Education Program (total cholesterol > 240 mg/dL, LDL-cholesterol >160 mg/dL, HDL-cholesterol < 40mg) or patients requiring statin during study period. Patients using statin at study entry were excluded but initiation of this drug was allowed during follow-up.

Results: Prospective evaluation of lipid profile revealed a significant increase in levels of total cholesterol (177±39mg/dL vs. 195±45mg/dL, p=0.002) and LDL-cholesterol (105±34mg/dL vs. 117±40mg/dL, p=0.007), in spite of statin introduction in one fourth of these patients during the study. No changes were found in the concentration of HDL-cholesterol (48±12mg/dL vs. 50±12mg/dL, p=0.26), triglycerides [105 (69-160)mg/dL vs. 112 (92-183)mg/dL  p=0.06], in AI (3.9±1.4 vs. 4.1±1.3, p=0.48), BMI (28.4±5.2kg/m2 vs. 29.1±5.7kg/m2, p=0.62) and waist circumference (92.2±15cm vs. 97.8±14.9cm, p=0.23. The frequency of patients with high risk levels for total cholesterol (6.3% vs. 28.1%, p=0.023) and high/very high LDL- (6.3% vs. 28.1%, p=0.023) significantly increased from entry to 104 weeks whereas no change in the frequency of HDL-cholesterol and triglycerides classification rate were observed. Anti-TNF treatment improved inflammation parameters: C-reactive protein (p<0.001), and erythrocyte sedimentation rate (p<0.001).

Conclusion: The novel demonstration that anti-TNF therapy has a specific pattern of long-term deleterious effect in lipid profile of PsA patients reinforces the importance of this cytokine as a potent lipid metabolism regulator and emphasizes the recommendation for a close monitoring and a more vigorous intervention in this modifiable cardiovascular risk factor.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/tnf-blockage-in-psoriatic-arthritis-long-term-effect-on-lipid-profile/