Carotid Intima-Media Thickness in Psoriatic Arthritis: Differences Between Tumor Necrosis Factor-α Blockers and Traditional Disease-Modifying Antirheumatic Drugs

• Published in: Arteriosclerosis, thrombosis, and vascular biology Vol. 31; no. 3; pp. 705 - 712
• Main Authors: Di Minno, Matteo Nicola Dario, Iervolino, Salvatore, Peluso, Rosario, Scarpa, Raffaele, Di Minno, Giovanni
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Heart Association, Inc 01.03.2011; Lippincott Williams & Wilkins
• Subjects: Adult; Analysis of Variance; Antirheumatic Agents - therapeutic use; Arthritis, Psoriatic - complications; Arthritis, Psoriatic - drug therapy; Arthritis, Psoriatic - immunology; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - etiology; Carotid Artery Diseases - immunology; Carotid Artery Diseases - prevention & control; Carotid Artery, Common; Case-Control Studies; Chi-Square Distribution; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heart; Humans; Inflammation Mediators - antagonists & inhibitors; Inflammation Mediators - metabolism; Italy; Linear Models; Male; Medical sciences; Middle Aged; Propensity Score; Risk Assessment; Risk Factors; Time Factors; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor Necrosis Factor-alpha - metabolism; Tunica Intima - diagnostic imaging; Tunica Media - diagnostic imaging; Ultrasonography, Doppler, Color; Skin disease; Psoriasis; Cytokine; Diseases of the osteoarticular system; Cardiovascular disease; Inflammatory joint disease; Inflammation; Artery; Psoriatic arthritis; Vascular disease; Spondylarthropathy; intima-media thickness; Chronic; Blood vessel; Carotid; tumor necrosis factor-α; Atherosclerosis; Circulatory system; Tumor necrosis factor α
• ISSN: 1079-5642; 1524-4636; 1524-4636
• DOI: 10.1161/ATVBAHA.110.214585

OBJECTIVE—Subjects with psoriatic arthritis (PsA) have an abnormally high prevalence of vascular risk factors (VRFs) and are predisposed to vascular mortality. Tumor necrosis factor (TNF)-α, a major determinant of inflammation, is involved in atherosclerosis. Ultrasonographic carotid intima-media thickness (C-IMT) evaluation allows for subclinical atherosclerosis detection. METHODS AND RESULTS—Two hundred twenty-four PsA patients (120 on TNF-α blockers and 104 on traditional disease-modifying antirheumatic drugs [DMARDs]) underwent a C-IMT ultrasound assessment. As many as 305 matched subjects without any inflammatory/rheumatologic disease served as controls. The C-IMT of PsA subjects without VRFs was higher (P<0.0001) than that of controls, the C-IMT of PsA subjects with ≥1 VRF(s) was lower (P<0.0001) than that of controls, and the C-IMT was lower (P<0.0001) in those on TNF-α blockers than in those on DMARDs. Carotid plaques were detected in 15.8% of those on TNF-α blockers and in 40.4% of those on DMARDs (P<0.0001). Treatment duration inversely (β=−0.317, P<0.0001) predicted C-IMT in PsA subjects on TNF-α blockers but not in those on DMARDs (P=0.313). CONCLUSION—Among PsA individuals, the C-IMT is higher in subjects on DMARDs than in those on TNF-α blockers. The reduction of inflammation may hamper the cascade that causes the raised vascular risk in PsA patients.