In AS, Anti-TNF-α Therapy Can Restore Microvascular Function

Anti-tumor necrosis factor-α (Anti-TNF- α) inhibitor therapy can replenish microcirculation function and capillary edema in patients with ankylosing spondylitis (AS), according to recent findings. 

The research further showed that microvascular dysfunction and capillary neovascular formation are associated with disease activity in AS. 

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Previous studies have focused on the dysfunction of large conduit vessels in AS. Less is known about microvascular dysfunction in AS and current research is limited.

Microvascular dysfunction is a key mechanism for hypertension, cognitive dysfunction, and heart failure. Characterization of microcirculation in AS and its link to disease activity is, therefore, important.

Previous studies have focused on the dysfunction of large conduit vessels in AS. Yet, little is known in relation to microvascular dysfunction in AS.

The researchers conducted Functional Laser Doppler Flowmetry with post-occlusive reactive hyperemia and structural nailfold capillaroscopy to compare microvascular morphology and function of 54 patients with AS with 28 matched healthy controls. 

The effect of 3-month TNF-α inhibitor therapy on microcirculation in AS was also studied.

Overall, results showed that patients with high disease activity who were treated with TNF-α inhibitors had more evident microvascular changes, improved blood flow in microcirculation, and reduced pericapillary edema.

AS was associated with lengthened time to peak hyperemia. High disease activity was associated with increased time to peak hyperemia and decreased peak hyperemia when compared with inactive AS.

In capillaroscopy, patients with AS had more morphological abnormalities—an indication of increased neoangiogenesis and pericapillary edema—compared with controls. 

Microvascular function, including basal flow and post-occlusive parameters, improved for patients after 3 months of TNF-α inhibitor therapy.

“This suggests that TNF-α inhibitors may be effective not only in improving the signs and symptoms of AS but also in preventing cardiovascular complications, warranting future randomized outcome trials,” the researchers concluded.

—Melinda Stevens

Reference:
Batko B, Maga P, Urbanski K, et al. Microvascular dysfunction in ankylosing spondylitis is associated with disease activity and is improved by anti-TNF treatment [Published September 4, 2018]. Sci Rep. https://doi.org/10.1038/s41598-018-31550-y.