Trend towards increased arterial stiffness or intima-media thickness in ankylosing spondylitis patients without clinically evident cardiovascular disease

Rheumatology (Oxford). 2008 Aug;47(8):1203-7. doi: 10.1093/rheumatology/ken198. Epub 2008 Jun 4.


Objectives: Increased incidence of cardiovascular disease (CVD) has been observed in AS. The reasons of this increase are not fully understood (greater prevalence of traditional cardiovascular risks, consequences of treatment (NSAID) or biological inflammation). The objectives of this study are to assess intima-media thickness (IMT) and arterial stiffness (i.e augmentation index AIx), markers of sub-clinical atherosclerosis in AS patients and to examine the effects of TNF-alpha inhibitors on arterial stiffness in active AS patients.

Methods: Sixty AS patients were enrolled with 60 healthy controls. Their BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and BASFI (Bath Ankylosing Spondylitis Functional Index) scores, ESR and CRP levels were recorded. Subclinical atherosclerosis was assessed by measurement of AIx by pulse wave analysis and IMT by carotid echography.

Results: We found significantly increased IMT in the AS group compared with healthy controls. After adjustment for confounding factors, an underlying trend towards increased IMT was still present (P = 0.06). No difference was found in arterial stiffness between the two groups. AS patients, treated or not with anti-TNF-alpha at baseline, had significantly increased IMT and AIx or a trend towards increase. IMT was positively correlated with tobacco use, WHR and blood pressure but not correlated with CRP level. Despite improvement in markers of disease activity, arterial stiffness was unchanged after 14 weeks of treatment with TNF antagonists.

Conclusion: This study shows a trend towards increased subclinical atherosclerosis in AS patients. TNF-alpha blockade does not seem to improve arterial stiffness in AS patients, but our results lack statistical power.

MeSH terms

  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Antirheumatic Agents / therapeutic use
  • Arteries / physiopathology
  • Atherosclerosis / etiology
  • C-Reactive Protein / metabolism
  • Carotid Artery, Common / pathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Severity of Illness Index
  • Spondylitis, Ankylosing / complications
  • Spondylitis, Ankylosing / drug therapy
  • Spondylitis, Ankylosing / pathology
  • Spondylitis, Ankylosing / physiopathology*
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • Tunica Intima / pathology*
  • Tunica Media / pathology*
  • Vascular Resistance* / drug effects


  • Anti-Inflammatory Agents, Non-Steroidal
  • Antirheumatic Agents
  • Tumor Necrosis Factor-alpha
  • C-Reactive Protein