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Tumour necrosis factor blocking agents and progression of subclinical atherosclerosis in patients with ankylosing spondylitis
  1. Alper M van Sijl1,2,3,
  2. Izhar C van Eijk1,
  3. Mike J L Peters3,
  4. Erik H Serné3,
  5. Irene E van der Horst-Bruinsma1,
  6. Yvo M Smulders3,
  7. Michael T Nurmohamed1,2,3
  1. 1Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
  2. 2Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands
  3. 3Department of Internal Medicine, Institute for Cardiovascular Research (ICAR), VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Alper M van Sijl, Department of Rheumatology, Jan van Breemen Research Institute Reade, Jan van Breemenstraat 2, PO Box 58271, 1040| HG, Amsterdam, The Netherlands; a.v.sijl{at}reade.nl

Abstract

Background Ankylosing spondylitis (AS) is associated with an increased cardiovascular risk that might be due to the chronic underlying inflammatory process. We investigated whether subclinical atherosclerosis of the carotid artery in patients with AS was reduced after anti-inflammatory treatment with tumour necrosis factor (TNF) inhibitors in a prospective observational cohort study.

Methods 67 out of 81 AS patients who used TNF inhibitors and underwent ultrasonography at baseline returned for follow-up after 4.9 years. Of all patients, 12 (15%) discontinued the use of TNF inhibitors. Assessments of medication use, AS-related factors and cardiovascular risk factors were measured at baseline and repeated at follow-up. B-mode carotid ultrasonography was used to investigate arterial wall parameters, including carotid intima-media thickness (cIMT) and Young's elastic modulus (YEM).

Results After a median 4.9 years of follow-up, cIMT did not change significantly (paired t test +0.011 mm, p=0.561) in those who continued the use of TNF inhibitors, while cIMT increased substantially (+0.057 mm, p=0.069) in those who did not continue their use of TNF inhibitors. The effect of TNF inhibitors was mainly mediated by a subsequent decrease in AS disease activity. Vascular elasticity (as measured with YEM) did not change significantly in patients who discontinued TNF inhibitors or those who continued TNF inhibitors.

Conclusions The use of TNF inhibitors might stabilise or slow down the progression of subclinical atherosclerosis in AS patients, reflecting a decreased cardiovascular risk in these patients.

  • Ankylosing Spondylitis
  • Atherosclerosis
  • TNF-Alpha
  • Ultrasonography
  • Cardiovascular Disease

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