Endothelial inflammation in patients with Rheumatoid Arthritis treated with Tofacitinib: an observational study

Autores: María Celina De la Vega, María Agustina Alfaro, Federico Benavidez, Cristian Alejandro Benítez, Martín Eleta, María Julieta Gamba, Ramiro Adrián Gómez, Juan José Real, Augusto Martín Riopedre, Gonzalo Rodríguez

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Introduction: cardiovascular involvement is frequent in patients with rheumatoid arthritis (RA). The use of tofacitinib has been linked with an increase in cardiovascular events in some populations of RA patients. 18F-fluorodeoxyglucose Positron Emission Tomography (PET-FDG/TC) has emerged as a sensitive and specific test for the evaluation of vascular wall inflammation.

Objectives: evaluate endothelial vascular inflammation using PET-FDG/TC in patients with active RA initiating tofacitinib at baseline and after 12 weeks of treatment.

Materials and methods: observational, prospective, multicentric study. Consecutive patients with RA with moderate/high activity, bDMARD-naive, who were to start tofacitinib were included. Clinical data, disease activity, and PET-FDG/TC were assessed at baseline and at week 12 of tofacitinib treatment. Endothelial inflammation was assessed using SUVmax and TBRmax. Carotid artery Doppler ultrasonography was performed at baseline and week 12, and intima-media thickness was measured.

Results: 30 patients were included, 70% female, median age 57.5 years (IQR 42-65), median RA duration 5 years (IQR 2-12), median DAS28ESR 5.24 (IQR 4.6-6.1), and median CDAI 27.5 (IQR 20-34). At week 12 of tofacitinib treatment, patients showed a significant decrease in disease activity according to DAS28ESR (5.21 vs 3.04, p<0.0001) and CDAI (26.6 vs 8.80, p<0.0001), but 18F-FDG uptake in the evaluated areas showed no significant difference between baseline and week 12, with all explored vascular areas showing an SUVmax above the predefined threshold for inflammation at baseline.

Conclusions: In our study, we found no change in vascular inflammation at week 12 of tofacitinib treatment, despite improvement in disease activity.