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Abstract Number: 1702

Tumor Necrosis Factor Blocking Agents Inhibit the Progression of Preclinical Atherosclerosis in Patients with Ankylosing Spondylitis

Alper M. van Sijl1, Izhar C. van Eijk2, Mike J.L. Peters3, Erik H. Serne3, Yvo M. Smulders4 and Mike T. Nurmohamed1, 1Rheumatology, Jan van Breemen Research Institute | Reade, Amsterdam, Netherlands, 2Rheumatology, VU University Medical Center, Amsterdam, Netherlands, 3Internal medicine, VU University Medical Center, Amsterdam, Netherlands, 4Internal Medicine, VU University Medical Center, Amsterdam, Netherlands

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Ankylosing spondylitis (AS), Cardiovascular disease, intima medial thickness and tumor necrosis factor (TNF)

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Session Information

Title: Spondylarthropathies and Psoriatic Arthritis - Clinical Aspects and Treatment: Spondyloarthritis II

Session Type: Abstract Submissions (ACR)

Background/Purpose: Ankylosing spondylitis (AS) is associated with an increased cardiovascular (CV) risk that might be due to the chronic underlying inflammatory process. It is still unknown whether strong anti-inflammatory treatment with tumor-necrosis factor (TNF) inhibitors reduce the increased CV risk in AS. We investigated whether preclinical atherosclerosis and elasticity of the carotid arteries in patients with AS changed after use of TNF-inhibitors.

Methods: 67 out of 82 AS patients who underwent ultrasonography at baseline were measured again after 5 years. Assessments of medication use, AS related factors, CV risk factors and arterial parameters (including intima-media thickness (IMT) and Young’s elastic modulus (YEM)) were repeated at follow-up. Spearman’s rank correlation were used to investigate the correlation between changes in AS related factors or CV risk factors with changes in arterial wall parameters.

Results: After a mean follow-up of 5 years, 11 AS patients (16%) discontinued their use of TNF inhibitors. IMT did not change significantly (+0.012, p-value= 0.561) in those who continued the use of TNF inhibitors as compared to AS patients who discontinued use of TNF inhibitors (+0.060, p-value=0.025). Also, vascular elasticity (as measured with YEM) improved significantly in patients who continued TNF inhibitors (+0.031, p-value=0.002) but not in patients who discontinued TNF inhibitors. Correlations were found between 1. Unfavourable changes in BASDAI, BASG, BASMI and increase in IMT, and 2. Unfavourable changes in total cholesterol, LDL-cholesterol, total-HDL-cholesterol ratio and decrease in vascular elasticity (as measured with YEM).

 Conclusion: Continuous use of TNF-inhibitors might stabilize or slow down IMT progression in AS patients, reflecting a decreased CV risk in these patients. Unfavourable changes in IMT were associated with equally unfavourable changes in AS related factors and unfavourable changes in vascular elasticity (as measured with YEM) were associated with unfavourable changes in lipid levels. The exact mechanism by which TNF inhibition modulates CV risk might be explained by different mechanisms (AS related factors and IMT vs. lipid levels and YEM).

 

Table 1. Correlations between changes in AS- and CV related factors and changes in arterial wall characteristics

 

Intima-media Thickness

Young’s Elastic Modulus

 

Correlation coefficient

p-value

Correlation coefficient

p-value

AS related factors

 

 

 

 

BASDAI

0.308 *

0.013

-0.201

0.117

BASFI

0.113

0.368

0.081

0.533

BASG

0.311 *

0.012

-0.167

0.195

BASMI

0.327 *

0.007

-0.062

0.632

ESR

0.030

0.822

-0.085

0.533

CRP

0.042

0.752

-0.114

0.401

CV risk factors

 

 

 

 

Systolic blood pressure

-0.075

0.559

-0.102

0.440

Diastolic blood pressure

-0.109

0.395

-0.016

0.902

Pulse pressure

0.002

0.986

-0.100

0.446

Body-mass index

-0.084

0.516

0.005

0.968

Total cholesterol

0.309 *

0.042

-0.276

0.076

HDL-cholesterol

0.081

0.612

0.137

0.401

LDL-cholesterol

0.251

0.123

-0.277

0.097

Total- to HDL-cholesterol ratio

0.117

0.462

-0.319 *

0.045

* p < 0.05


Figure 1. Changes in IMT and BASMI, YEM and Total cholesterol to HDL-cholesterol ratio


Disclosure:

A. M. van Sijl,
None;

I. C. van Eijk,
None;

M. J. L. Peters,
None;

E. H. Serne,
None;

Y. M. Smulders,
None;

M. T. Nurmohamed,
None.

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