Microvascular function is impaired in ankylosing spondylitis and improves after tumour necrosis factor α blockade

Abstract

Objectives: Ankylosing spondylitis (AS) is associated with increased cardiovascular morbidity and mortality. Microvascular function has been linked to several risk factors for cardiovascular disease. Inflammation in AS may cause microvascular dysfunction. To test this, we assessed microvascular function in (a) patients with AS compared to healthy controls and (b) patients with AS before and after 1 month of anti-tumour necrosis factor (TNF)a treatment with etanercept. Methods: A total of 15 consecutive patients with AS, who were scheduled for etanercept treatment according to the Assessment in Ankylosing Spondylitis (ASAS) group guidelines, and 12 healthy controls matched for age and sex, were recruited. Endothelium-dependent and independent vasodilatation in skin were evaluated with laser Doppler fluxmetry after iontophoresis of acetylcholine and sodium nitroprusside, respectively. Videomicroscopy was used to measure recruitment of skin capillaries after arterial occlusion. Results: Compared to healthy controls, patients with AS had impaired endothelium-dependent vasodilatation and capillary recruitment. Following anti-TNFa treatment, microvascular function improved significantly for endothelium-dependent vasodilatation (p = 0.03) and capillary recruitment (p = 0.006). A significant correlation was observed between changes in endothelium-dependent vasodilatation and changes in erythrocyte sedimentation rate (ESR) (r = 20.56; p = 0.03). Conclusion: Microvascular dysfunction is present in patients with AS with active disease, but improves as inflammation regresses after TNFa blockade.

Anti-TNF therapy in ankylosing spondylitis: insights for the clinician

“…A Dutch group analysed endothelial microvascular function in patients with AS before and after treatment with etanercept. They confirmed impaired microvascular function in AS patients compared to controls and also showed a significant improvement in some parameters following 1 month's treatment with etanercept [Van Eijk et al 2009]. Further data are needed to see if this improvement in microvascular function correlates with an improvement in ongoing cardiovascular risk.…”

Tumor Necrosis Factor-α Antagonists Improve Aortic Stiffness in Patients With Inflammatory Arthropathies

“…19,20 Moreover, treatment with TNF-␣ antagonists is reported by a few small studies to improve endothelial function and aortic stiffness in patients with RA 11,21,22 and microvascular function in patients with AS. 14 Aortic pulse wave velocity (aPWV), a measure of aortic stiffness, is considered the current gold standard for measuring arterial stiffness. 9 The effect of treatment with TNF-␣ antagonists on aPWV in other inflammatory arthropathies than RA was, to our knowledge, not explored previously.…”

Metabolic Syndrome in Patients With Ankylosing Spondylitis

“…In another study, the lower HDL cholesterol values were observed to be correlated with the intensity of the inflammation [25]. Van Eijk et al have observed in their study that the increases in the sedimentation rate and CRP values caused significant decreases in the HDL cholesterol levels [26]. Based on these results, it can be concluded that the cause of the lower HDL values in the patients with AS may play a partial role in the inflammation and the cardiovascular diseases.…”