INFLAMMATION is increasingly recognized as a pivotal factor in the development of atherosclerosis and its associated thrombotic complications. This connection is particularly significant for patients with immune-mediated arthritic conditions, such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondyloarthritis (SpA), who face an elevated risk of cardiovascular events. A recent structured review sheds light on the potential benefits of tumor necrosis factor inhibitors (TNFis) in addressing this concern.
The review highlights that TNF plays a pathological role in both vascular and joint diseases, suggesting that TNFis may help reduce cardiovascular events in patients with RA, PsA, or SpA. Clinical studies indicate that TNFis can decrease vascular inflammation and may improve or prevent the worsening of endothelial dysfunction and arterial stiffness. Notably, evidence points to a reduction in the incidence of cardiovascular events among patients with inflammatory arthritis treated with TNFis compared to those receiving non-biological treatments, especially in RA cases.
Comparative studies between different classes of biological therapies have not shown significant differences in cardiovascular event risks between patients on TNFis and those on other biological treatments. However, for patients at high cardiovascular risk, TNFis may offer greater benefits than Janus kinase inhibitors (JAKis). The cardiovascular impact of JAKis remains a topic of debate, underscored by recent safety warnings.
The review emphasizes that targeted inflammation control is a crucial strategy to reduce major adverse cardiovascular events in patients with inflammatory arthritis. It recommends a multidisciplinary approach involving both rheumatology and cardiology specialists for cardiovascular evaluation and risk stratification to guide optimal immunomodulatory treatment.
In summary, TNFis emerge as a promising therapeutic option not only for managing arthritic symptoms but also for mitigating associated cardiovascular risks. Ongoing research and collaborative clinical practices are essential to fully understand and harness the cardiovascular benefits of TNFis in inflammatory arthritis care.
Reference: Opinc-Rosiak AH et al. Infections as a predominant cause of death in adult patients with idiopathic inflammatory myopathies. Clin Exp Rheumatol. 2025;43(2):290-299.
Anaya Malik | AMJ
