title: Carotid intima-media thickness in psoriatic arthritis: differences between tumor necrosis factor-α blockers and traditional disease-modifying antirheumatic drugs.
abstract: 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)-α, a major determinant of inflammation, is involved in atherosclerosis. Ultrasonographic carotid intima-media thickness (C-IMT) evaluation allows for subclinical atherosclerosis detection.
  
  
  RESULTS
  Two hundred twenty-four PsA patients (120 on TNF-α 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-α blockers than in those on DMARDs. Carotid plaques were detected in 15.8% of those on TNF-α blockers and in 40.4% of those on DMARDs (P<0.0001). Treatment duration inversely (β=-0.317, P<0.0001) predicted C-IMT in PsA subjects on TNF-α blockers but not in those on DMARDs (P=0.313).
  
  
  CONCLUSIONS
  Among PsA individuals, the C-IMT is higher in subjects on DMARDs than in those on TNF-α blockers. The reduction of inflammation may hamper the cascade that causes the raised vascular risk in PsA patients.
authors.affiliation: Department of Clinical and Experimental Medicine, Regional Reference Centre for Coagulation Disorders, Federico II University, Via S Pansini 5, 80131, Naples, Italy. dario.diminno@hotmail.it
authors.forename: Matteo Nicola Dario
authors.initials: MN
authors.lastname: Di Minno
authors.forename: Salvatore
authors.initials: S
authors.lastname: Iervolino
authors.forename: Rosario
authors.initials: R
authors.lastname: Peluso
authors.forename: Raffaele
authors.initials: R
authors.lastname: Scarpa
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Minno
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D017536:Carotid Artery, Common; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000037:antagonists & inhibitors* / Q000378:metabolism; D007558:Italy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D018615:Ultrasonography, Doppler, Color
chemical_list: D018501:Antirheumatic Agents; D018836:Inflammation Mediators; D014409:Tumor Necrosis Factor-alpha