Prospective, simultaneous assessment of joint and vascular inflammation by PET/CT in tofacitinib-treated patients with rheumatoid arthritis: associations with vascular and bone status

Abstract

### Key messages #### What is already known about this subject? #### What does this study add? #### How might this impact on clinical practice or further developments?. Please check and provide Rheumatoid arthritis (RA) has been associated with accelerated atherosclerosis, increased cardiovascular (CV) morbidity and mortality, as well as metabolic changes.1 2 Targeted therapies may have beneficial effects on CV outcomes1 3 4 and metabolism2 5 in RA. Four Janus kinase (JAK) inhibitors including tofacitinib have been approved for RA.6 JAK inhibition has been associated with lipid elevation7; however, it had no CV consequences.1 7 Vascular inflammation may precede atherosclerosis. Traditionally, ultrasound-based techniques have been applied to assess preclinical vascular pathophysiology in RA.1 8 Early endothelial dysfunction indicated by abnormal brachial artery flow-mediated vasodilation (FMD), overt atherosclerosis shown by the presence of carotid plaques and increased common carotid intima–media thickness (IMT), as well as arterial stiffness indicated by increased arterial pulse-wave velocity (PWV) have been reported in association with RA.1 8–11 These preclinical abnormalities predict the development of subsequent CV events in arthritis.1 8 Biologics may, at least transiently, dampen the progression of abnormal FMD, IMT and PWV in RA (reviewed in Szekanecz et al 3). There has been only one study showing that tofacitinib decreased carotid atherosclerosis.12 18F-fluorodeoxyglucose-positron emission tomography/CT (18F-FDG-PET/CT) may be able to simultaneously detect tissue inflammation all over the …