Background Ankylosing spondylitis (AS) is associated with an increased cardiovascular (CV) risk that might be due to the chronic underlying inflammatory process, but is still unknown whether treatment with TNF inhibitors reduce the increased CV risk.
Objectives We investigated whether preclinical atherosclerosis of the carotid arteries in patients with AS were reduced after use of TNF inhibitors in an observational cohort study.
Methods 67 out of 82 AS patients who underwent ultrasonography at baseline returned for follow-up. Of the 67 remaining AS patients, 11 discontinued use of TNF inhibitors. Assessments of AS related factors and CV risk factors were measured at baseline and repeated at follow-up. B-mode carotid ultrasonography was used to investigate arterial wall parameters, including intima-media thickness (IMT) and Young’s elastic modulus (YEM).
Results After 5 years of follow-up, IMT did not change significantly (+0.012, p-value= 0.561) in those who continued the use of TNF inhibitors, whereas IMT increased significantly (+0.060, p-value=0.025) in AS patients who discontinued use of TNF inhibitors. Compared to prior studies in rheumatoid arthritis (a disease with comparable CV risk as in AS) AS patients who discontinued TNF inhibitors had a comparable yearly increase in IMT, while patients who continued use of TNF inhibitors had a 5-fold lower increase in IMT. Duration of use of TNF inhibitors (in years) was associated with stabilization or regression of IMT, odds ratio (95%>confidence interval): 1.67 (1.04-2.63). Also, YEM improved significantly in patients who continued TNF inhibitors (+0.037, p-value=0.002) but not in patients who discontinued TNF inhibitors.
Conclusions (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, while unfavourable changes in YEM were associated with unfavourable changes in lipid levels. More research is needed to investigate the relationship between improvement in AS-related disease acitivity indices and improvement in IMT or vascular stiffness.
Disclosure of Interest None Declared
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