Background Cardiovascular (CV) morbidity and mortality are increased in patients with arthritides, including ankylosing spondylitis (AS). Biologics may influence vascular function and lipids in AS, however a lot more information has become available in rheumatoid arthritis. In addition, most studies have been short-term and less information has become available on etanercept (ETN) in comparison to other biologics, such as infliximab.
Objectives We wished determine vascular damage and lipid profile in AS and the effects of ETN on common carotid intima-media thickness (ccIMT), brachial artery flow-mediated, endothelium-dependent vasodilatation (FMD) and the arterial stiffness marker pulse wave velocity (PWV) in context with laboratory assessments after 12 months of biological therapy.
Methods Seventeen AS patients (14 males, 3 females) with a mean age of 42.6 years and a mean disease duration of 7.2 years were included. 50mg weekly ETN therapy was administered and patients were assessed at baseline and after 12 months of treatment. Brachial and carotid ultrasonography was performed to determine FMD, ccIMT and PWV, respectively. We also assessed immunological, inflammatory and metabolic laboratory markers.
Results At baseline, meanccIMT was 0.47 mm (normal range: 0.4-0.9 mm), mean FMD was 6,9% (normal: >10%) and the mean PWV was 6.4 m/s (normal range: 4-20m/s). At baseline, a significant inverse correlation was observed between CRP and HDL-C levels (R=-0.518, p=0.033). ccIMT strongly correlated with BASDAI R=0.881, p=0.001). After 12 months of anti-TNF treatment, BASDAI (from 6.14 to 1.25; p<0.001), CRP (from 13.4 to 2.3 mg/l; p=0.002). FMD (from 6.9% to 9.3%; p=0.01) and PWV (from 6.4 to 5.4 m/sec, p=0.045) significantly improved, while ccIMT showed no change. There have been no significant changes in lipid levels.
Conclusions In patients with AS, FMD, a marker of endothel dysfunction and PWV, a marker of arterial stiffness significantly improved after 12 months of anti-TNF treatment with ETN. These beneficial vascular changes were associated with improved disease activity. ccIMT may require more time to improve.
Disclosure of Interest None Declared
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