title: Can suppression of inflammation by anti-TNF  prevent progression of subclinical atherosclerosis  in inflammatory arthritis?
abstract: OBJECTIVE
  It remains a matter of debate whether TNF-a antagonists have favourable effects on the cardiovascular (CV) system. This systematic review evaluates the effect of TNF-a blockers on the progression of subclinical atherosclerosis and arterial stiffness in patients with inflammatory arthritis.
  
  
  METHODS
  A search of the MEDLINE and Web of Knowledge databases was conducted to identify studies into the effect of TNF-a antagonists on subclinical atherosclerosis and arterial stiffness in patients with RA, AS and PsA. Carotid intimamedia thickness (cIMT) was used to assess subclinical atherosclerosis. Two methods were used to assess arterial stiffness: pulse wave velocity (PWV) and aortic augmentation index (AIx). Twenty-three studies matching the search criteria were included for analysis.
  
  
  RESULTS
  TNF-a blockers probably are effective in preventing (7/13 studies) or even reversing (5/13 studies) the progression of IMT in patients with RA, AS and PsA who are responding to treatment. With regard to arterial stiffness, PWV was either significantly reduced (7/13 studies) or remained unchanged (6/13 studies) following TNF-a antagonist treatment. Nonetheless, most studies in RA (7/10) reported significant improvement of PWV. AIx remained unchanged in 10 of 13 studies.
  
  
  CONCLUSIONS
  The balance of evidence suggests that TNF-a antagonists may have a beneficial effect on preventing the progression of subclinical atherosclerosis and arterial stiffness. It remains unknown whether this effect is specific to TNF-a antagonists or relates to better control of inflammation irrespective of the disease modification strategy by which this is achieved.
authors: Lai-Shan
authors: LS
authors: Tam
authors: George D
authors: GD
authors: Kitas
authors: Miguel A
authors: MA
authors: González-Gay
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001168:Arthritis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D050197:Atherosclerosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D001688:Biological Products / Q000627:therapeutic use*; D059168:Carotid Intima-Media Thickness; D018450:Disease Progression; D006801:Humans; D063177:Pulse Wave Analysis; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D059289:Vascular Stiffness / Q000187:drug effects
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha