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

• Main Authors: E. I. Markelova (Author), D. S. Novikova (Author), T. V. Korotaeva (Author), E. Yu. Loginova (Author)
• Format: Book
• Published: Столичная издательская компания, 2018-11-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1819-6446; 2225-3653; 10.20996/1819-6446-2018-14-5-711-715
• Keywords: early psoriatic arthritis; inhibitor of tumor necrosis factor-alpha; carotid intima-media thickness; arterial stiffness; ambulatory blood pressure monitoring; Therapeutics. Pharmacology; RM1-950; Diseases of the circulatory (Cardiovascular) system; RC666-701
• Source: Рациональная фармакотерапия в кардиологии, Vol 14, Iss 5, Pp 711-715 (2018)

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.