Ab0943 evaluation of the Effect of Tumor Necrosis Factor - Α Therapy on 24-Hour Ambulatory Blood Pressure Measurement and Sleep Quality in Patients With Axial Spondyloarthritis

Abstract

BackgroundIncreased cardiovascular mortality has been reported in AS patients. There are studies showing the positive effects of anti-TNF-α therapy on both cardiovascular mortality and sleep quality. (1,2)ObjectivesTo determine the changes in sleep quality and 24-hour blood pressure readings in patients with axial spondiloarthritis (axSpA) after treatment with anti- tumor necrosis factor TNF-α therapy.MethodsPatients with axSpA who were admitted to Hacettepe University Hospital Rheumatology outpatient clinic between 01.03.2021 and 01.12.2021, anti-TNF-naive and without a history of cardiovascular disease were included. Disease activitiy assesment (ESR, CRP, BASDAI and BASFI), ambulatory blood pressure measurement (AMBP) and sleep quality evaluated by pittsburgh sleep quality index questionare (PSQI) were assessed before ant-TNF therapy (0.month) and after anti-TNF-α therapy (3.month).ResultsTotally, 28 patients with axSpA (mean (SD) age 40.0 (10.4) years, female:16(57.1%) patients) were included in to this study (table-1). The 0th and 3th month ABPM measurements of the patients in our study were within the normotensive limits. Both disease activity scores and median PSQI scores [8.5 (4.0-12.8)] were high and sleep quality was poor in 71% of the patients. Although there was a significant decrease in disease activity scores and a significant improvement in sleep quality at the 3. month after anti-TNF- α therapy, no significant changes were observed in ABPM parameters such as Ambulatory Arterial Stiffness İndex (AASI), Average real Variability (ARV), Pulse Pressure İndex (PPI), Sleeptroughsurge and Prewaking surge compared to pre-treatment. While after anti- anti-TNF-α therapy the percentage of patients with dipper phenomena increased in the 3. month, this increase was not statistically significant (46.4% (0. month) vs. 60.7% (3. month); p=0.388). Furthermore, the change in nighttime systolic blood pressure reduction was statistically significant respectively ([4.8% ((-7) – 9.2) (0. month) vs. 9.2% (4.7-11.1) (3. month); p=0.020], while there was no statistically significant difference in the change in nighttime diastolic blood pressure reduction respectively ([6.4% (1.5-14.7) vs. 9.6% (5.0-15.8); p=0.112] (table-2).ConclusionThis study shows that anti-TNF-α treatment has positive effects on modifiable cardiovascular risk factors by increasing sleep quality and increasing nighttime blood pressure reduction. Prospective and long-term studies are needed.References[1]Atzeni F, et. al. Cardiovascular risk in ankylosing spondylitis and the effect of anti-TNF-α drugs: a narrative review. Expert Opin Biol Ther. 2020;20(5):517-24.[2]Karadağ O, et. al. Effect of anti-TNF-α treatment on sleep problems in ankylosing spondylitis. Rheumatol Int. 2012;32(7):1909-13.Table 1.Baseline demographic and clinical characteristics of the patientsMen/ Women n (%)12 (42.9%)/ 16 (57.1%)Age*years40.0±10.4Disease duration** years6,5 (4-11)HLA-B27 positivityn (%)13(59,1%)Peripheral manifestationsn (%)1 (3,6%) Uveitisn (%)- Psoriasisn (%)- Dactilitisn (%)- Entesithisn (%)- IBDn (%)- VAS-Pain**7.5 (5.3 – 9.0) BASDAI** (0-10)5.8 (3.5-7.1) BASFI** (0-10)6.4 (3.6-7.3) ESR**(mm/h)14.0 (6.3-30.0) CRP**(mg/dL)0.8 (0.3-2.3) BMI*(kg/m2)27.2±5.6 LDL(mg/dL)*123.7±38.4 HDL(mg/dL)*50.2±10.1Triglycerides(mg/dL)*117.7±71.9Smokingn (%)13 (46.4%)Obesen (%)9 (32,1%)Medicaitons*NSAID n (%)28 (100%)kDMARD n(%)17 (60,7%)Steroid#n(%)4 (14.3%)Mean±standard deviation **(Median 25%-75%)# <7.5 mg prednisone or equivalentBASDAI (Bath Ankylosing Spondylitis Disease Activity Index), BASFI (Bath Ankylosing Spondylitis Functional Index), IBD (Inflammatory bowel disease), ESR (Erythrocyte-Sedimentation Rate), CRP (C-reactive protein), BMI (Body mass index), NSAID (Non-steroidal anti-inflammatory drug), kDMARD (conventional DMARD), steroid (users under <7.5 mg). Those who were obese were considered as having a BMI >30.Acknowledgements:NIL.Disclosure of InterestsNone Declared.