Background: Although cardiovascular (CV) diseases are very common in inflammatory arthritis like psoriatic arthritis (PsA), long-term impact of medication on CV outcomes is lacking.
Objectives: The aim of our study was to evaluate the long-term effects of anti-TNF-a drugs on subclinical atherosclerosis assessed by the flow-mediated dilatation (FMD) and carotid intima media thickness (IMT).
Methods: A total of 30 patients with PsA according to classification of psoriatic arthritis (CASPAR) criteria1 and 28 healthy controls were enrolled in this cross-sectional study between June 2011-July 2012. 22 out of 30 PsA patients completed the study. Demographic data (sex, age), PsA and psoriasis duration, joint pattern (monoarthritis, oligoarthritis or polyarthritis) and other PsA involvements (nail, enthesis, dactilytis) were noted. Tender joint count, swollen joint count and disease activity score (DAS)-28 were used for joint activity assessment. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used for acute phase reactants. Sex and age matched healthy controls were selected as the control group for this study. Flow mediated dilatation (FMD) from brachial artery and carotid intima media thickness (IMT) were measured by an experienced cardiologist both at initial and 5-year follow-up visits.
Results: Psoriasis duration of PsA patients was 180±114 months. PsA disease duration was 108±33 months. The mean duration between two evaluations was 62±9 months. At first evaluation, 14 (63.6%) patients had peripheral joint, 1 (4.5%) patient had axial, and 7 (31.8%) patients had both peripheral and axial involvement among patients. Dactilytis in 6 (27.3%), enthesis in 7 (31.8%) and nail in 12 (54.5%) patients were other clinical involvements. FMD% was lower in PsA patients than healthy controls [9.3±3.9 vs 12.9±1.8, p<0.001] and carotid IMT was more obvious in PsA patients than healthy controls [0.64±0.17 vs 0.54±0.09, p=0.017] (Figure). All PsA patients used anti-TNF alpha treatment during the follow-up period. 68.1% of the PsA patients were in remission during the control. At 5-year follow-up visits, there was no CV event in study groups. However, FMD% was lower in PsA patients than healthy controls [7.6±4.8 vs 12.9±1.8, p<0.001] and carotid IMT was also similar between PsA patients and healthy controls [0.61±0.33 vs 0.54±0.09, p=0.306]. After 5-year follow-up visits, there was no statistically significant difference in FMD% compared to baseline [p = 0.254]. ΔFMD% was found to be moderately correlated with the ΔBASDAI (r= -0.45).
Conclusion: Our results showed that there was a significant impact of anti-TNF-a drugs on progression of subclinical atherosclerosis at the vascular wall level, but no impact on the endothelial dysfunction. Further large-scale randomized studies are needed to confirm our findings.
Disclosure of Interests: Abdulsamet Erden: None declared, Uğur Canpolat: None declared, Oğuz Abdullah Uyaroğlu: None declared, Cem Çöteli: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Umut Kalyoncu Grant/research support from: MSD, Roche, UCB, Novartis and Pfizer, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Speakers bureau: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Omer Karadag: None declared, Ali İhsan Ertenli: None declared, Sedat Kiraz: None declared, Kudret Aytemir: None declared, Şule Apraş Bilgen: None declared
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