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Vascular effects of achieving low disease activity in axial spondyloarthritis – A 2-year prospective treat-to-target study

Year: 2026

Type: article

Abstract: To investigate the effect of achieving Axial Spondyloarthritis Disease Activity Score (ASDAS) low disease activity (LDA) on the progression of subclinical atherosclerosis and arterial stiffness in axial spondyloarthritis (axSpA) patients. Ninety-nine axSpA patients underwent 2 years of tight-control treatment aiming at ASDAS LDA (<2.1). Carotid intima-media thickness (cIMT) was measured using high-resolution ultrasound. Arterial stiffness was measured using brachial-ankle pulse wave velocity (baPWV) and augmentation index (AIx). The primary outcome was the effect of achieving LDA at 12 months (LDA group) on the progression of subclinical atherosclerosis over 24 months. Secondary outcomes included: (1) arterial stiffness progression between LDA and non-LDA groups; (2) subclinical atherosclerosis and arterial stiffness markers between patients who achieved sustained LDA (sLDA) from 12 to 24 months, and the non-sLDA groups over 24 months. Ninety axSpA patients (mean age: 39 ± 10 years, 81.1% male) were included. At 12 months, 74.4% (n = 67) achieved LDA, while 50.0% (n = 45) attained sLDA at 24 months. Multivariate analysis showed achieving LDA at 12 months reduced carotid plaque progression (OR 0.27, 95% CI 0.08-0.95, P = 0.042), while achieving sLDA was associated with less progression in the total plaque area (RR −1.97, 95% CI −3.83 to −0.12, P = 0.038) over 24 months. The changes in cIMT and arterial stiffness between patents who did or did not achieve LDA/sLDA were similar. Effective suppression of inflammation in axSpA patients achieving LDA may be associated with a reduction in subclinical atherosclerosis progression. • What is already known about this subject? Systemic inflammation drives excess cardiovascular disease (CVD) risk in axial spondyloarthritis (axSpA) by accelerating atherosclerosis. • What this study adds? Protocolized treatment LDA at 12 months reduced subclinical atherosclerosis progression at 24 months in axSpA patients. • How this study might affect research, practice or policy? Treat-to-target for persistent LDA should be incorporated into future axSpA treatment guidelines to prevent atherosclerosis progression.

Source: Journal of Autoimmunity

DOI: 10.1016/j.jaut.2026.103534