TNF Inhibitors May Slow Plaque Progression

For the internal carotid artery bulb, the authors found four significant predictors of plaque change: hormone replacement therapy, cumulative average swollen joint count, cumulative C-reactive protein level, and age. Neither exposure to TNF inhibitors nor exposure to glucocorticoids was related to plaque progression in the bulb.

C-reactive protein did not exert a linear effect on plaque progression or on the appearance of incident plaque until it reached 12 mg/L or more. This threshold of change was significantly lower in patients with higher Framingham scores or diabetes at baseline (5 mg/L).

The role of statins in modifying progression is complicated, the authors stated. “Notably, statin use was associated with almost no progression of [common carotid plaque] in RA patients with longer disease duration, an observation supporting the use of statins in RA,” they said.

“Interestingly, however, statin use was not associated with lower [common carotid progression] among participants with earlier disease. This may suggest differing mechanisms for [common carotid plaque] progression in early vs. late disease.”

The additional finding that statins attenuated the risk exerted by glucocorticoid exposure “deserves additional study and, short of a confirmatory trial, suggests that statins could be considered in RA patients receiving glucocorticoids.”

Baseline TNF inhibitor use reduced the annual progression rate by 37% compared with those not using the drugs.

Source DR. GILES