Impact of Anti-tumor Necrosis Factor (Anti-TNF) Therapy on Cardiovascular Risk in Patients With Ankylosing Spondylitis.

BACKGROUND

A chronic inflammatory condition, ankylosing spondylitis (AS), raises the risk of cardiovascular (CV) disease because of ongoing systemic inflammation.

OBJECTIVE

To evaluate the impact of anti-TNF therapy on CV risk markers and surrogate indicators of subclinical atherosclerosis in patients with AS, and to examine the influence of modifiable lifestyle factors such as smoking, physical activity, and body mass index (BMI) on CV outcomes.

METHODOLOGY: This descriptive observational study was conducted at the Department of Rheumatology, Fauji Foundation Hospital, Rawalpindi, from April 2022 to March 2024. The study included 246 patients with AS who had been on anti-TNF medication for at least three months. At baseline, six months, and 12 months, clinical and laboratory parameters such as blood pressure, BMI, lipid profile, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured. Doppler ultrasonography was used to measure the carotid intima-media thickness (CIMT) in 197 individuals (80.08%). Multivariate regression was used to account for physical activity, smoking, age, and BMI.

RESULTS

Among 246 patients (189 males, 76.8%; mean age, 41.2 ± 9.7 years), significant reductions were observed over 12 months in inflammatory, lipid, and cardiovascular markers (all P < 0.001). CRP decreased from 15.2 ± 5.7 to 5.3 ± 3.9 mg/L, with 177 (71.95%) showing >50% reduction. ESR declined from 38.4 ± 10.6 to 17.4 ± 7.8 mm/hour, with 166 (67.48%) showing >50% reduction. Low-density lipoprotein (LDL) decreased from 131.5 ± 18.7 to 113.4 ± 14.9 mg/dL, with a ≥10% reduction in 153 (62.20%), while high-density lipoprotein (HDL) increased from 38.9 ± 6.8 to 47.2 ± 7.3 mg/dL, with a ≥10% increase in 134 (54.47%). Systolic BP dropped from 136.9 ± 12.2 to 126.8 ± 10.9 mmHg, with a ≥10 mmHg reduction in 121 (49.19%). BMI also declined significantly from 27.6 ± 3.8 to 26.3 ± 3.2 kg/m². Among 197 patients with Doppler ultrasound, CIMT regressed in 142 (72.08%), with right CIMT decreasing from 0.84 ± 0.11 to 0.74 ± 0.09 mm and left CIMT from 0.86 ± 0.10 to 0.75 ± 0.08 mm. Multivariate analysis identified smoking and higher BMI as predictors of adverse changes, while physical activity was protective. Despite these improvements, unhealthy dietary habits remained prevalent, underscoring the need for lifestyle interventions alongside therapy.

CONCLUSIONS

Anti-TNF therapy significantly improves inflammatory, lipid, and vascular parameters, thereby reducing CV risk in patients with AS.