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Dynamics of Carotid Intima-Media Thickness, Parameters of Arterial Stiffness and Ambulatory Blood Pressure Monitoring during Therapy with Inhibitor of Tumor Necrosis Factor-Alpha in Patients with Early Psoriatic Arthritis

https://doi.org/10.20996/1819-6446-2018-14-5-711-715

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Abstract

Background. Patients with psoriatic arthritis (PsA) have increased risk of cardiovascular diseases (CVD). Anti-tumor necrosis factor (TNF) therapy is an effective in PsA but its cardiovascular effects are poorly understood.

Aim. To study the changes in carotid intima-media thickness (c-IMT), parameters of arterial stiffness (AS), ambulatory blood pressure monitoring (AMBP) in early PsA (EPsA) patients during the anti-TNF therapy with adalimumab (ADA).

Material and methods. Patients with EPsA (n=16; 11 females, 5 males; median age 45.5 years, EPsA duration – 7.7  months) were included into the study. All patients were treated with ADA 40 mg every other week up to 3 months. At baseline and after 3 months of therapy all patients were assessed  for conventional cardiovascular risk factors, DAS (Disease Activity Score) and  HAQ (Health Assessment Questionnaire) indices, C-reactive protein (CRP), c-IMT, ABPM. At baseline the  4 patients had  arterial hypertension, and  all patients received effective antihypertensive therapy. All patients were assessed for AS parameters: carotid-femoral pulse wave velocity (PWVcf) and index of wave reflection (rigidity index; RI, %). c-IMT was measured using a high-resolution B-mode ultrasound machine. The results are presented in the form of a median – Me (25; 75 percentiles).

Results. By the end of the 3rd month of therapy, a decrease in the activity of early PsA was observed as compared to baseline values: DAS decreased from 4.6 (2.9; 1.9) to 1.6 (1.3; 1.9), p=0,001; HAQ from 0.93 (0.81; 1.31) to 0.25 (0; 0.56), p=0,001; CRP from 27.2 (9.7; 33.7) to 1.8 (0.8; 3.1) mg/l, p=0.001. EPsA remission (DAS<1.6) was achieved in 94% of patients. By the end of therapy c-IMT decreased from 0.8 (0.74; 0.85) to 0.73 (0.58; 0.77) mm, p=0,01; as well as AS parameters: PWVcf from 9.9 (7.7; 17.7) to 9.2 (7.4; 10.6) m/s, p<0.05; RI from 69.5 (58; 74) to 49.5 (44; 64)%, p<0.05. AMBPs parameters didn't change significantly. We found significant (p=0.03) decrease in the frequency of the increase in 24-hour diastolic blood pressure.

Conclusions. Anti-TNF treatment with ADA improves arterial wall state by decreasing inflammation. These data confirm the idea that inflammation involves in acceleration of atherosclerosis in EPsA patients. 

About the Authors

E. I. Markelova
V.A. Nasonova Research Institute of Rheumatology
Russian Federation

Evgenia I. Markelova – MD, PhD, Senior Researcher,  Rheumocardiology Laboratory.

Kashirskoe shosse 34A, Moscow  115522.

 



D. S. Novikova
V.A. Nasonova Research Institute of Rheumatology
Russian Federation

Diana S. Novikova – MD, PhD, Leading Researcher,  Rheumocardiology Laboratory.

Kashirskoe shosse 34A, Moscow  115522.

 



T. V. Korotaeva
V.A. Nasonova Research Institute of Rheumatology
Russian Federation

Tatiana V. Korotaeva – MD, PhD, Head of Laboratory of Diagnostics and Innovative Methods of Psoriatic Arthritis Treatment.

Kashirskoe shosse 34A, Moscow  115522.

 



E. Yu. Loginova
V.A. Nasonova Research Institute of Rheumatology
Russian Federation

Elena Yu. Loginova – MD, PhD, Senior Researcher,  Laboratory of Diagnostics and Innovative Methods of Psoriatic Arthritis Treatment.

Kashirskoe shosse 34A, Moscow  115522.

 



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For citation:


Markelova E.I., Novikova D.S., Korotaeva T.V., Loginova E.Y. Dynamics of Carotid Intima-Media Thickness, Parameters of Arterial Stiffness and Ambulatory Blood Pressure Monitoring during Therapy with Inhibitor of Tumor Necrosis Factor-Alpha in Patients with Early Psoriatic Arthritis. Rational Pharmacotherapy in Cardiology. 2018;14(5):711-715. (In Russ.) https://doi.org/10.20996/1819-6446-2018-14-5-711-715

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