Background: Spondyloarthritis is a chronic inflammatory disease associated with increased cardiovascular morbidity and mortality due to accelerated atherosclerosis. Recent studies have reported the benefit of TNF inhibitors in reducing the risk of cardiovascular events and its association with changes in lipid profile. Nevertheless, it remains controversial.

Objectives: We aimed to investigate the effect of TNF inhibitors on subclinical atherosclerosis assessed with carotid intima-media thickness (CIMT) and flow mediated dilatation (FMD) in patients with spondyloarthritis (SpA).

Methods: We performed a cross sectional study including 47 patients meeting ASAS 2009 criteria for SpA. Patients with traditional cardiovascular risk factors were excluded. We collected clinical data, therapeutic modalities and biological tests including total cholesterol, HDL, LDL and triglyceride after 12 hours of fasting. FMD and mean CIMT (mean value of right and left carotid artery) were measured with a Mindray Resona 7 ZST+ ultrasound machine by an experienced radiologist.

Results: Among the 47 subjects, 18 patients (38%) were receiving TNF inhibitors for a median duration of 36 months (IQR 25-75%: 24-72) (9 were on Etanercept, 7 were on Adalimumab, one patient was on Infliximab and one was on Golimumab). The group treated with TNF inhibitors had a median age of 43 years (IQR 25-75%: 36-46.5) and a median duration of the disease of 12 years (IQR 25-75%: 9.5-22). Median ASDAS and BASDAI scores were 2.40 (IQR 25-75%: 1.48-3.1) and 2.60 (IQR 25-75%: 1.55-3.75) respectively. On the other hand, patients naïve to TNF inhibitors had a median age of 32 years (IQR 25-75%: 55-42), median disease duration of 7 years (IQR 25-75%: 3-12.5), median ASDAS of 2.13 (IQR 25-75%: 1.61-2.91), and median BASDAI of 2.40 (IQR 25-75%: 1.55-3.75).

When comparing the two groups, there was no significant difference regarding disease activity scores ASDAS (p=0.431) and BASDAI (p=0.793) as well as biochemical variables; total cholesterol (p=0.483), HDL (p=0.395), LDL (p=0.263) and triglyceride (0.092). In contrast, patients on TNF inhibitors were significantly more aged (p=0.009) and had a significantly higher duration of the disease (p=0.004).

Doppler ultrasound examination showed a median CIMT of 0.56 mm (0.48-0.64) in patients treated with TNF inhibitors versus 0.55 mm (0.48-0.60) in patients naïve to TNF inhibitors with no significant difference (p=0.238). Patients on TNF inhibitors had lower values of FMD (with a median of 12.5 (6.7-16) versus 15.5 (10-24.5)). However this difference was not significant (p=0.182).

Conclusion: In our study, biological treatment with TNF inhibitors did not affect endothelial function and subclinical atherosclerosis in patients with spondyloarthritis. Given the small size of our study population and its heterogeneity in terms of age and duration of the disease, no conclusions can be drawn. Further longitudinal studies that involve larger samples are necessary.

Disclosure of Interests: None declared