THE EFFECT OF AN ANTI-TUMOR NECROSIS FACTOR-? AGENT ON DISEASE ACTIVITY, BLOOD RHEOLOGICAL PROPERTIES, AND THE ARTERIAL WALL IN PSORIATIC ARTHRITIS
<i>Vascular dysfunction and inflammation in psoriatic arthritis (PsA) share the same pathogenetic mechanism wherein the proinflammatory cytokine tumor necrosis factor-</i> <i>(TNF-</i><i>) plays a key role. Treatment with anti-TNF-</i> <i>agents is effective in inhibiting inflammation in PsA; however, their effect on the wall of large arteries has not been studied. Objective. To evaluate the effect of Adalimumab (ADA) on the arterial wall and blood rheological properties in PsA. Subjects and methods. Eighteen patients with PsA [12 women and 6 men; mean age 43.1±10.2 years; disease activity scores (DAS), 4.78 (4.0; 5.45)] were subcutaneously injected ADA, 40 mg/every two weeks, for 12 weeks. The investigators assessed the vascular wall, by measuring the mean and maximum common carotid intima-media thickness (IMT) by ultrasound duplex scanning, and arterial rigidity (AR), by determining the refraction index (RI,%) and the rigidity index by digital volume photoplethysmography and Doppler study measuring the aortic pulse wave velocity (PWV) in the carotid-femoral segment (Micromedical, UK), before and after treatment. Erythrocyte aggregation (EA) parameters [Т1 (sec), Kt (c.u.); </i> <i>(sec-1), I2,5 (%)] were measured recording the rate of inverse light scattering and the levels of blood lipids [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG)], and atherogenicity coefficient (AC) by routine methods on an automated Express plus analyzer (Bayer, Germany) at baseline, 4, and 12 weeks. The median and the interquartile range [Me (Q25; Q75)] were calculated; the changes in the parameters were estimated by the Wilcoxon test (Wt) and the Friedman test (Ft) for dependent samples; p<0.05 was considered statistically significant. Results. Along with a significant reduction in PsA activity [DAS from 4.79 (4.0; 5.45) tо 1.6 (1.3; 2.03), Ft.; p < 0.05], there was a considerable improvement in the arterial wall (the mean IMT decreased from 0.78 (0.74; 0.84) to 0.73 (0.61; 0.74), Wt.; p < 0.028) and most AR parameters (there were reductions in RI from 69.5 (58; 74) to 49.5 (44; 64), Wt; p < 0.005) and aortic PWV from 9.9 (7.7; 17.7) to 9.2 (7.4; 10.6), Wt; p < 0.05). The baseline EA values [T1 = 5.98 (5.42; 6.99), Kt = 0.39 (0.33; 0.53), </i> <i>= 58.32 (47; 77.3), I2,5 = -8 (-9; -7) significantly improved at just 4 weeks of treatment [Т1 = 8.77 (7.9; 10.1); Кt = 0.22 (0.17; 0.28); </i> <i>= 32.46 (20.7; 42.49), I2,5= -26 (-29; -20)] and preserved their positive changes at 12 weeks [Т1 = 9.2 (8.4; 11.4); Кt = 0.22 (0.2; 0.27); </i> <i>= 34 (26.5; 41.9), I2,5 = -27.5 (-32; -22)] (Ft; p < 0.002 for all EA parameters). ADA treatment caused a significant increase in TC and TG from 4.9 (4.1; 5.8) to 5.5 (4.9; 6) and from 0.85 (0.75; 1.26) to 1.09 (0.94; 1.43), respectively; Wt; p < 0.007/0.021). AC remained unchanged. Conclusion. ADA lowers PsA activity, normalizes blood rheological properties, and improves the wall of large arteries as reductions in carotid IMT and AR parameters associated with the vessels of the microcirculatory bed.</i>