Soluble vascular biomarkers in rheumatoid arthritis and ankylosing spondylitis: Effects of 1-year antitumor necrosis factor-α therapy

Anita Pusztai, Attila Hamar, Agnes Horvath, Katalin Gulyas, Edit Vegh, Nora Bodnar, Gyorgy Kerekes, Monika Czokolyova, Szilvia Szamosi, Levente Bodoki, Katalin Hodosi, Andrea Domjan, Gábor Nagy, Ibolya Szollosi, Luis R. Lopez, Eiji Matsuura, Zoltan Prohaszka, Sandor Szanto, Zoltan Nagy, Yehuda ShoenfeldZoltan Szekanecz*, Gabriella Szucs

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective. Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have been associated with cardiovascular disease. The treatment of arthritis by tumor necrosis factor-α (TNF-α) inhibitors may decrease the serum concentrations of vascular biomarkers. We determined circulating levels of oxidized low-density lipoprotein (oxLDL)/β2 glycoprotein I (β2-GPI) complexes, antibodies to 60 kDa heat shock protein (anti-Hsp60), soluble urokinase plasminogen activator receptor (suPAR), and B-type natriuretic peptide (BNP) fragment in sera of RA and AS patients undergoing anti-TNF treatment. Methods. Fifty-three patients with RA/AS were treated with etanercept or certolizumab pegol for 1 year. Circulating oxLDL/β2-GPI complex (AtherOx), anti-Hsp60 IgG, and BNP8-29 fragment levels were assessed by ELISA. suPAR levels were determined by suPARnostic Quick Triage test. Flow-mediated vasodilation (FMD), carotid intima-media thickness (CIMT), and arterial pulse wave velocity (PWV) were determined by ultrasound. Results. One-year anti-TNF treatment significantly decreased oxLDL/β2-GPI levels, as well as suPAR levels in patients with critically high suPAR levels at baseline. In RA, BNP levels were higher in seropositive vs seronegative patients. Serum levels of these vascular biomarkers variably correlated with lipids, anticitrullinated protein antibodies, rheumatoid factor, and C-reactive protein. CIMT positively correlated with BNP, and PWV with suPAR and anti-Hsp60, whereas FMD inversely associated with anti-Hsp60. In repeated measures ANOVA analysis, disease activity supported the effects of anti-TNF treatment on 12-month changes in oxLDL/β2-GPI. CIMT supported the effects of therapy on changes in anti-Hsp60 and suPAR. Conclusion. These biomarkers may be involved in the pathogenesis of atherosclerosis underlying RA/AS. TNF inhibition variably affects the serum levels of oxLDL/β2-GPI, suPAR, and BNP.

Original languageEnglish
Pages (from-to)821-828
Number of pages8
JournalJournal of Rheumatology
Issue number6
StatePublished - 1 Jun 2021
Externally publishedYes


  • Angiogenesis
  • Anti-TNF therapy
  • Atherosclerosis
  • Biomarkers
  • Rheumatoid arthritis


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