Impact of effective tumor necrosis factor-alfa inhibitor treatment on arterial intima-media thickness in psoriasis: results of a pilot study

J Am Acad Dermatol. 2013 Oct;69(4):523-9. doi: 10.1016/j.jaad.2013.06.019. Epub 2013 Jul 23.


Background: Psoriasis is associated with higher incidence of atherosclerotic comorbidities. Sustained arterial wall inflammation mediated by common cytokines of psoriasis and atherogenesis precedes atherosclerotic plaque development. Increased intima-media thickness (IMT) is an accepted indicator of subclinical atherosclerosis and has been reported in severe psoriasis.

Objective: This pilot study aimed to clarify whether effective long-term tumor necrosis factor-alfa inhibition decreases IMT in psoriasis.

Methods: In 16 patients with severe psoriasis, the Psoriasis Area and Severity Index score was calculated before therapy (etanercept, infliximab, adalimumab) and after 6-month treatment. Simultaneously, carotid and brachial IMT was measured by high-resolution, B-mode ultrasonography. Difference between initial and 6-month IMT values was determined for monitored arteries collectively and separately in carotid and brachial arteries.

Results: All of 16 patients achieved Psoriasis Area and Severity Index 75, and 14 of 16 achieved Psoriasis Area and Severity Index 90 improvement. In the group of patients without initial calcified atherosclerotic plaques (13 of 16) significant IMT decrease was detected when arteries were measured collectively (P = .0002). Initial and follow-up data differed significantly also at individual analysis of carotid (P = .011) and brachial (P = .006) arteries. Eleven of 13 patients had initial carotid IMT exceeding age-adjusted normal values. The other group (3 of 16) with initial manifest plaques showed increasing IMT tendency. Their baseline ultrasonography revealed carotid IMT above the upper limit of healthy adults' age-adjusted values.

Limitations: Study limitation involves small patient numbers, self-controlled study design, and lack of patients' stratification according to common cardiovascular risk factors.

Conclusion: In our pilot study effective tumor necrosis factor-alfa inhibition was found to decrease IMT in psoriatic patients without irreversible atherosclerotic plaques. Further analysis is recommended to confirm and complete our primary observations.

Keywords: (18)F-fluoro-deoxyglucose; CT; FDG; IMT; PASI; PET; Psoriasis Area and Severity Index; T-helper cell; TNF; Th; arterial intima-media thickness; atherosclerosis; cardiovascular risk; computed tomography; high-resolution B-mode ultrasonography; intima-media thickness; positron emission tomography; psoriasis vulgaris; tumor necrosis factor; tumor necrosis factor-alfa inhibitor.

MeSH terms

  • Adult
  • Aged
  • Brachial Artery
  • Carotid Intima-Media Thickness
  • Cohort Studies
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Psoriasis / diagnostic imaging
  • Psoriasis / drug therapy*
  • Psoriasis / physiopathology
  • Risk Assessment
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Tumor Necrosis Factor-alpha / therapeutic use*
  • Tunica Intima / diagnostic imaging
  • Tunica Intima / drug effects
  • Tunica Intima / pathology*
  • Tunica Media / diagnostic imaging
  • Tunica Media / drug effects
  • Tunica Media / pathology
  • Ultrasonography, Interventional
  • Young Adult


  • Tumor Necrosis Factor-alpha