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

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)-alpha, 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-alpha 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-alpha blockers than in those on DMARDs. Carotid plaques were detected in 15.8% of those on TNF-alpha blockers and in 40.4% of those on DMARDs (P<0.0001). Treatment duration inversely (beta=-0.317, P<0.0001) predicted C-IMT in PsA subjects on TNF-alpha 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-alpha blockers. The reduction of inflammation may hamper the cascade that causes the raised vascular risk in PsA patients. (Arterioscler Thromb Vasc Biol. 2011;31:705-712.)