Popescu Diana, Badescu Minerva Codruta, Rezus Elena, Tanase Daniela Maria, Ouatu Anca, Dima Nicoleta, Buliga-Finis Oana-Nicoleta, Gosav Evelina Maria, Rezus Ciprian
Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania.
3rd Internal Medicine Clinic, "Saint Spiridon" County Emergency Clinical Hospital, 700111 Iasi, Romania.
J Clin Med. 2025 Jul 2;14(13):4676. doi: 10.3390/jcm14134676.
Patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) exhibit increased cardiovascular risk, partly attributed to persistent systemic inflammation. Janus kinase inhibitors (JAKi) effectively reduce inflammation, but their impact on cardiovascular risk remains unclear. This pilot study aimed to evaluate the effect of JAKi therapy on systemic inflammation and lipid markers, correlate traditional cardiovascular risk factors with biological parameters, and quantify subclinical atherosclerosis progression. : We conducted a prospective, single-center study including 48 patients receiving JAKi. Clinical, inflammatory, lipid, and vascular parameters were assessed at baseline (T0) and after 12 months (T1). Primary endpoints included changes in carotid intima-media thickness (cIMT), ankle-brachial index (ABI), and carotid plaque presence. Mean cIMT significantly decreased from 0.29 mm to 0.125 mm ( = 0.019), while ABI improved modestly, but not significantly (0.125 to 0.04, = 0.103). Carotid plaque prevalence increased slightly from 39.6% to 47.9%, = 0.159. C-reactive protein (CRP) levels declined significantly, while interleukin (IL)-1β levels increased. Lipoprotein(a) [Lp(a)] levels decreased significantly (mean reduction -7.96 mmol/L, = 0.001). Multivariate regression identified Lp(a) as an independent predictor of carotid plaque at both T0 ( = 0.011) and T1 ( = 0.005). Baseline ABI was a significant predictor of acute cardiovascular events [hazard ratio (HR): 4.614, 95% CI: 1.034-20.596, = 0.045]. : JAKi therapy significantly reduced systemic inflammation and cIMT in patients with autoimmune rheumatic diseases, suggesting a potential benefit in attenuating early vascular changes. However, residual cardiovascular risk remains in patients with low ABI and elevated Lp(a), warranting close monitoring.
类风湿关节炎（RA）和银屑病关节炎（PsA）患者的心血管风险增加，部分原因是持续性全身炎症。Janus激酶抑制剂（JAKi）可有效减轻炎症，但其对心血管风险的影响尚不清楚。这项前瞻性研究旨在评估JAKi治疗对全身炎症和脂质标志物的影响，将传统心血管危险因素与生物学参数相关联，并量化亚临床动脉粥样硬化的进展。我们进行了一项前瞻性单中心研究，纳入48例接受JAKi治疗的患者。在基线（T0）和12个月后（T1）评估临床、炎症、脂质和血管参数。主要终点包括颈动脉内膜中层厚度（cIMT）、踝臂指数（ABI）的变化以及颈动脉斑块的存在情况。平均cIMT从0.29毫米显著降至0.125毫米（P = 0.019），而ABI虽有适度改善但不显著（从0.125至0.04，P = 0.103）。颈动脉斑块患病率从39.6%略有增加至47.9%，P = 0.159。C反应蛋白（CRP）水平显著下降，而白细胞介素（IL）-1β水平升高。脂蛋白（a）[Lp（a）]水平显著降低（平均降低-7.96毫摩尔/升，P = 0.001）。多变量回归分析确定Lp（a）在T0（P = 0.011）和T1（P = 0.005）时均为颈动脉斑块的独立预测因子。基线ABI是急性心血管事件的显著预测因子[风险比（HR）：4.614，95%置信区间：1.034 - 20.596，P = 0.045]。JAKi治疗可显著减轻自身免疫性风湿病患者的全身炎症和cIMT，提示在减轻早期血管病变方面可能有益。然而，ABI较低和Lp（a）升高的患者仍存在残余心血管风险，需要密切监测。
