Endothelial inflammation in patients with Rheumatoid Arthritis treated with Tofacitinib

Introduction: Cardiovascular involvement is frequent in patients with Rheumatoid Arthritis (RA). The use of tofacitinib has been linked with an increment 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. The aim of this study is to evaluate the endothelial vascular inflammation using PET-FDG/TC in patients with active RA initiating tofacitinib, at baseline and after 12 weeks of treatment. Methods Observational, prospective, multicentric study. Consecutive patients with RA with moderate/high activity, bDMARD naïve, that were to start tofacitinib were included. Clinical data, disease activity and analytics were assessed. PET-FDG/TC was performed at baseline (week 0) and at week 12 of tofacitinib treatment. Endothelial inflammation was assessed using SUV max and TBR max . Carotid arteries 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 (IQR 42–65) years old, median RA duration 5 (IQR 2–12) years, Median DAS28ESR 5.24 (IQR 4.6–6.1) median CDAI 27.5 (IQR 20–34). At week 12 of tofacitinib treatment, patients showed a significant decrease in disease activity by 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 five evaluated areas showed no significant difference between baseline and week 12 with all explored vascular showing a SUV max over the prestipulated threshold defining inflammation at baseline. Conclusion In our study, we found no change in vascular inflammation at week 12 of tofacitinib treatment, despite improvement in disease activity.