Anti-inflammatory therapy and cardiovascular disease in inflammatory arthropathies Effects of TNF-α antagonists on vascular function and structure

Background: Anti-Tumor Necrosis Factor (TNF)-α therapy seems to improve vascular pathology in patients with inflammatory arthropathies such as rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Asymmetric dimethylarginine (ADMA) competes with Larginine as a substrate for nitric oxide synthase (NOS) and the L-arginine/ADMA ratio is important for modulation of the NOS activity. We examined the effect of TNF-α antagonists on circulatory ADMA and L-arginine/ADMA, and associations between ADMA, Larginine/ADMA, aortic stiffness and carotid intima media thickness (CIMT) in patients withinflammatory arthropathies.Methods: Fifty-five patients with a clinical indication for anti-TNF-α therapy were included. 36 patients started with anti-TNF-α therapy and were compared with a non-treated group of 19 patients. Plasma ADMA, L-arginine and aortic stiffness (aortic pulse wave velocity, aPWV) were assessed at baseline, 3 and 12 months. CIMT was examined at baseline and 12