Original articleEffects of 14 weeks of TNF alpha blockade treatment on lipid profile in ankylosing spondylitis
Introduction
Increased cardiovascular morbidity and mortality have been observed in several inflammatory rheumatic diseases, including rheumatoid arthritis (RA) and spondylarthropathies [1], [2], [3], [4], [5], [6]. Patients with ankylosing spondylitis (AS) have an overall mortality of about 1.6–1.9 times that of the general population, and excess mortality from circulatory or cardiovascular disease (CVD) has been estimated at 20–40% [6]. The causes underlying this increased incidence of CVD are not entirely understood. AS patients have dyslipidemia with decreased HDL-cholesterol and increased atherogenic index [7]. In a recent survey of men with AS, there was an increased percentage of smokers and a higher rate of body mass index compared with age-matched healthy controls [8]. In RA, traditional coronary risk factors such as hyperlipidemia, smoking, hypertension and diabetes have been implicated in but do not account for the increased risk of CVD [9]. Conversely, disease severity has consistently been associated with an increased risk of CVD, indicating that systemic inflammation is a major determinant of vascular comorbidity [10]. In AS, C-reactive protein (CRP), interleukin-6 and fibrinogen were significantly elevated, which suggests that systemic inflammation may predispose to CVD, but conclusive evidence is lacking [8]. Inflammatory biomarkers are good predictors for cardiovascular events in both the general population and inflammatory polyarthritis patients [11], [12].
TNF alpha inhibitor treatments have properties that might decrease cardiovascular risk in RA [13], but only in patients who respond to anti-TNF therapy [14]. This decrease may be due to a decrease in biological inflammation or to improvement of the pro-atherogenic lipid profile, which has already been observed after TNF alpha blockade treatment in RA [15]. However, reports on the effects of anti-TNF alpha therapy on lipid profile in RA are conflicting, and in AS, there is a lack of documented evidence.
In the present study, we assessed the effect of 14 weeks’ treatment of TNF alpha blockade on lipid profile in patients with AS.
Section snippets
Methods
We studied 34 patients with AS who all met the New York diagnostic criteria [16]. Clinical assessment and laboratory examinations were recorded at baseline and after 14 weeks of TNF alpha blockade.
Results
Ten female and 24 male (70.59%) patients with a mean age of 43 ± 12 years were enrolled. At baseline, 13 patients were on NSAID (38.24%), seven on methotrexate (20.59%) with a median dose of 7.5 mg/week, one on other DMARDs [sulfasalazine (n = 1)] and one was receiving prednisone. Dose of DMARDs, steroids and NSAIDs were stable during the study. Twenty patients were started on infliximab (58.82%), seven on etanercept (20.59%) and seven on adalimumab (20.59%) for an active disease (Table 1).
Fourteen
Discussion
We found that 14 weeks of TNFalpha inhibitor treatment and especially monoclonal antibodies induced a significant increase in both total cholesterol and HDL-cholesterol levels. However, these changes did not modify the atherogenic index, an important risk factor for future cardiovascular events that should be taken into account in treatment of dyslipidemia in RA [19]. At the same time, there was a significant decrease in clinical disease activity and in biological inflammation.
It is now well
References (29)
- et al.
Cardiovascular diseases in patients with spondylarthropathies
Joint Bone Spine
(2008) - et al.
Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis
Semin Arthritis Rheum
(2004) - et al.
Lipids, lipoproteins, and apolipoproteins as risk markers of myocardial infarction in 52 countries (the INTERHEART study): a case-control study
Lancet
(2008) - et al.
Mortality in rheumatoid arthritis patients with disease onset in the 1980s
Ann Rheum Dis
(1999) - et al.
The epidemiology of rheumatoid arthritis in Rochester. Minnesota: a study of incidence, prevalence, and mortality
Am J Epidemiol
(1980) - et al.
Mortality in early “sawtooth” treated rheumatoid arthritis patients during the first 8-14 years
Scand J Rheumatol
(1999) Mortality and causes of death in 398 patients admitted to hospital with ankylosing spondylitis
Ann Rheum Dis
(1993)- et al.
Ankylosing spondylitis; survival in men with and without radiotherapy
Arthritis Rheum
(1980) - et al.
Increased disease activity is associated with a deteriorated lipid profile in patients with ankylosing spondylitis
Ann Rheum Dis
(2006) - et al.
Cardiovascular risk parameters in men with ankylosing spondylitis in comparison with non-inflammatory control subjects: relevance of systemic inflammation
Clinical Science
(2005)
High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors
Arthritis Rheum
Increased incidence of cardiovascular disease in patients with rheumatoid arthritis: results from a community based study
Ann Rheum Dis
Inflammation as a cardiovascular risk factor
Circulation
Baseline levels of C-reactive protein and prediction of death from cardiovascular disease in patients with inflammatory polyarthritis: a ten-year follow up study of a primary care-based inception cohort
Arthritis Rheum
Cited by (44)
Benefits of tumor necrosis factor inhibitors for cardiovascular disease in ankylosing spondylitis
2022, International ImmunopharmacologyCitation Excerpt :Thus, these results indicated that TNFi treatment has beneficial effects in lowering CVD risk. Table 1 summarizes the studies [33–82] which used serum biomarkers and other non-invasive techniques to determine the effects of TNFi on CVD in AS patients. In the early years, studies on this topic yielded contradictory results.
Subclinical Cardiovascular Damage in Systemic Rheumatic Diseases
2017, Handbook of Systemic Autoimmune DiseasesTargeting inflammation in the prevention of cardiovascular disease in patients with inflammatory arthritis
2016, Translational ResearchPharmacology
2015, Textbook of Pediatric RheumatologyCardiovascular risk type in patients with ankylosing spondylitis
2014, Revue du Rhumatisme (Edition Francaise)