Background and Objectives Cardiovascular (CV) morbidity and mortality are increased in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Biologics may influence vascular function and lipids in arthritides, however, most studies have been short-term and less information has become available on etanercept (ETN) and certolizumab pegol (CZP). We wished determine the effects of these TNF blockers 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 in RA and AS patients after 12 months of biological therapy.
Materials and Methods Twenty-seven RA patients (23 female, 4 male) and 17 AS patients (14 males, 3 females) were included. RA patients received either ETN or CZP and AS patients were treated with ETN for 12 months. Brachial and carotid ultrasonography was performed to determine FMD, ccIMT and PWV, respectively. We also assessed immunological, inflammatory and metabolic laboratory markers.
Results In RA, at baseline, mean ccIMT was 0.56 mm (normal range: 0.4-0.9 mm), mean FMD was 6,5% (normal: >10%) and the mean PWV was 8.4 m/s (normal range: 4-20m/s). At baseline, ccIMT correlated with disease duration (R = 0.446, p = 0.015), while FMD and PWV did not. ccIMT (R = 0.393, p = 0.023) and PWV (R = 0.511, p = 0.005) also correlated with age at RA onset. PWV correlated with serum triglyceride levels. In AS, at baseline, mean ccIMT 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 in RA, DAS28 (p < 0.001), CRP (p = 0.004). FMD (p = 0.04) and PWV (p = 0.035) significantly improved. In AS, 12 months of ETN treatment resulted in significant improvement in 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), while ccIMT showed no change. There have been no significant changes in lipid levels in AS.
Conclusions In patients with RA and AS, FMD, a marker of endothel dysfunction and PWV, a marker of arterial stiffness significantly improved after 12 months of anti-TNF treatment. ccIMT may require more time to improve. These beneficial vascular changes were associated with improved disease activity.