Can suppression of inflammation by anti-TNF prevent progression of subclinical atherosclerosis in inflammatory arthritis?

Objective. It remains a matter of debate whether TNF-alpha antagonists have favourable effects on the cardiovascular (CV) system. This systematic review evaluates the effect of TNF-alpha 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-alpha antagonists on subclinical atherosclerosis and arterial stiffness in patients with RA, AS and PsA. Carotid intima-media 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-alpha 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-alpha antagonist treatment. Nonetheless, most studies in RA (7/10) reported significant improvement of PWV. AIx remained unchanged in 10 of 13 studies. Conclusion. The balance of evidence suggests that TNF-alpha 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-alpha antagonists or relates to better control of inflammation irrespective of the disease modification strategy by which this is achieved.