Atherosclerosis progression in psoriatic arthritis patients despite the treatment with tumor necrosis factor-alpha blockers: A two-year prospective observational study

Objective: To evaluate the progression of subclinical atherosclerosis in Psoriatic Arthritis (PsA) patients treated with anti-tumor necrosis factor (TNF)-alpha. agents. Methods: Thirty-two PsA patients classified according to the CASPAR criteria and attending the Rheumatology Unit of the University of Padua Medical Center were enrolled in a two-year prospective, observational study. In accordance with the ASAS/EULAR recommendations on the management of these patients, those studied were prescribed biological agents [etanercept (n= 21), adalimumab (n= 6), influximab (n= 5)]. Plasma lipids, inflammatory biomarkers, including C-reactive protein (CRP), interleukin-6 (IL-6), vessel endothelium growth factor (VEGF), osteoprotegerin (OPG), and TNF-alpha., as well as Disease Activity Score 28 calculated with CRP (DAS 28-CRP) were evaluated at baseline and after two years of treatment. Bilateral carotid B-mode ultrasound measurements [the mean-intima media thickness ( meanIMT), the mean maximum-IMT (M-Max)] of each carotid artery segment (common, bulb, and internal carotid artery) and the post-occlusion flow-mediated dilation (FMD) of the brachial artery were also assessed at baseline and after two years. Results: Despite an improvement in the DAS 28-CRP score (P< 0.0005) and lower low-density lipoprotein cholesterol (P< 0.013) and triglyceride (13 < 0.036) values, there was a significant progression in both the mean-IMT (P< 0.0005) and M-Max (P< 0.0005). Moreover, no recovery in FMD (13= ns) was observed after two years of anti TNF-alpha. treatment. Serum TNF-alpha levels were increased (P= 0.003) and OPG values were decreased (13= 0.011) at the end of follow- up with respect to baseline values. Conclusions: Despite improvement in clinical status, arterial remodelling was observed in the PsA patients who were treated with anti TNF-alpha agents for two years. (C) 2014 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.