04.02 Examination of Effects of TNF-Alpha Antagonists on Arterial Stiffness in Patients with Rheumatoid Arthritis and Related Arthropathies: A Controlled Study

Abstract

Objective

It has been suggested that the chronic inflammatory state of rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) contributes to accelerated atherosclerosis. The aim of this study was to evaluate the effect of anti-TNF-α therapy on arterial stiffness in patients with RA, AS and PsA.

Methods

35 patients (RA = 17, AS = 12 and PsA = 6) who started with anti-TNF-α therapy (adalimumab = 15, etanercept = 12, infliximab = 8) and a non-treatment group of 25 patients (RA = 12, AS = 9 and PsA = 4) underwent measurements of aortic Pulse Wave Velocity (aPWV) and Augmentation Index (AIx) at baseline and after 3 months (Sphygmocor). Patients in the non-treatment group had the same indications for anti-TNF-α therapy, but had to postpone their initiation due to positive Mantoux-test or planned operations. Results: Patients who started anti-TNF-α therapy had a significant decrease in aPWV (-0.465 m/s) whereas the patients in the control group had no change (+0.061 m/s, p = 0.002 for between group changes). Between group differences for AIx were not observed (change -0.62% and +0.44%, p = 0.48). As expected, a significant reduction in CRP (-9.2 mg/l, p = 0.011) and DAS28 for the RA patients (-0.73, p = 0.002) was observed in the treatment group, but we did not find significant correlations between change in aPWV and CRP in the entire treatment group (r = 0.055, p = 0.785) and between change in aPWV and DAS28 in the RA group (r = 0.091, p = 0.737).

Conclusion

These findings indicate that anti-TNF-alpha therapy ameliorates functional parameters of early atherosclerosis. However, changes in aPWV were not correlated to improvement in markers of inflammatory activity.