Optimal Management of Comorbid Patients with Spondyloarthritis: Focus on Cardiovascular Safety

Abstract

Comorbidity and multimobidity are typical for rheumatic diseases (RD) in general. Comorbidities have a complex negative impact on the patient with RD: they are often a direct cause of the premature death of patients, they may contribute to the severe course of the inflammatory process, comorbidities reduce choice of treatment options. Spondyloarthritis, such as psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), is also characterized by the frequent presence of comorbid conditions, in particular, cardiovascular diseases. Pleiotropic effects of pro-inflammatory cytokines such as interleukin 17A (IL-17A) promote these processes. IL-17A is a versatile pro-inflammatory T cell cytokine. At the same time, there is evidence that IL-17 involved in many other pathological processes: bone tissue remodeling, the development of endothelial dysfunction, formation of the unstable atherosclerotic plaques, heart ventricle remodeling after ischemic attack, etc. Clinical data confirm the role of hyperproduction of IL-17A in the development of cardiovascular diseases. On the example of Secukinumab IL-17A inhibition in PsA and axSpA, it has been shown that this treatment is associated with a high level of cardiovascular safety, and it is likely may help reduce cardiovascular risk. Therapy with IL-17A inhibitors, in particular, Secukinumab, in combination with generally accepted methods of correction of traditional cardiovascular risk factors, may be a promising direction in the management of patients with SpA and concomitant cardiovascular diseases