Background: Accelerated inflammatory atherosclerosis, as well as increased cardiovascular (CV) morbidity and mortality have been associated with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Natural autoantibodies (nAAbs) have been implicated in both arthritides and atherosclerosis. The possible effects of anti-TNF therapy on these nAAbs are largely unknown.

Objectives: Therefore we assessed the effects of one-year anti-TNF therapy on nAAbs in association with several other biomarkers.

Methods: Altogether 53 patients including 36 RA patients treated with either etanercept (ETN) or certolizumab pegol (CZP) and 17 AS patients treated with ETN were included in a 12-month follow-up study. Ultrasonography was performed to determine flow-mediated vasodilation (FMD), common carotid intima-media thickness (ccIMT) and arterial pulse-wave velocity (PWV) in all patients. Among nAAbs, anti-citrate synthase (CS) and anti-topoisomerase fragment 4 (TOPO-F4) IgM and IgG, as well as anti-Heat shock protein 60 (Hsp60) IgG levels were determined by in-house ELISA. All assessments were performed at baseline and 6 and 12 months after treatment initiation. Simple Pearson’s correlation, uni- and multivariable regression, RM-ANOVA and two-way ANOVA analyses were performed.

Results: One-year anti-TNF therapy transiently improved FMD and maintained ccIMT and PWV in RA and AS. TNF inhibition significantly increased anti-CS IgM and IgG, anti-TOPO-F4 IgG after 12 months versus baseline (p<0.005). There was no change in anti-hsp60 levels overtime. In various correlation analysis, anti-CS and anti-TOPO-F4 variably correlated with disease activity, rheumatoid factor, ACPA, FMD and PWV (p<0.005). Anti-TOPO-F4 IgG also correlated with anti-Hsp60 IgG (p<0.005). RM-ANOVA and two-way ANOVA confirmed that changes in anti-CS and anti-TOPO-F4 levels overtime variably correlated with changes of CRP, disease activity, FMD, ccIMT and PWV overtime (p<0.005).

Conclusion: TNF inhibition improved or stabilized vascular pathophysiology in RA and AS. Biologic therapy also increased anti-CS and anti-TOPO-F4 levels. The production of nAAbs was variably associated with, among other parameters, CRP, disease activity and vascular pathophysiology suggesting that nAAbs might form a link between arthritis and atherosclerosis.

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: Zoltán Szekanecz Abbvie, Roche, Pfizer, MSD, Richter, Lilly, Novartis, Abbvie, Roche, Pfizer, MSD, Richter, Lilly, Novartis, Pfizer, Diana Simon: None declared, Dorottya Kacsándi: None declared, Anita Pusztai: None declared, Boglárka Soós: None declared, Edit Végh: None declared, György Kerekes: None declared, Monika Bodoki: None declared, Szilvia Szamosi: None declared, Gabriella Szücs: None declared, Peter Nemeth: None declared, Timea Berki: None declared.