2 Iconography
Access to the text (HTML) Access to the text (HTML)
PDF Access to the PDF text

Access to the full text of this article requires a subscription.
  • If you are a subscriber, please sign in 'My Account' at the top right of the screen.

  • If you want to subscribe to this journal, see our rates

Journal of the American Academy of Dermatology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le mercredi 24 juillet 2013
Doi : 10.1016/j.jaad.2013.06.019
accepted : 13 June 2013
Impact of effective tumor necrosis factor-alfa inhibitor treatment on arterial intima-media thickness in psoriasis: Results of a pilot study

Hajnalka Jókai, MD , József Szakonyi, MD, Orsolya Kontár, MD, Márta Marschalkó, DsC, PhD, Klára Szalai, MD, Sarolta Kárpáti, DsC, PhD, Péter Holló, PhD
 Department of Dermatovenerology and Oncodermatology, Semmelweis University, Budapest, Hungary 

Correspondence to: Hajnalka Jókai, MD, Department of Dermatovenerology and Oncodermatology, Semmelweis University, Mária Street 41, Budapest 1085, Hungary.

Psoriasis is associated with higher incidence of atherosclerotic comorbidities. Sustained arterial wall inflammation mediated by common cytokines of psoriasis and atherogenesis precedes atherosclerotic plaque development. Increased intima-media thickness (IMT) is an accepted indicator of subclinical atherosclerosis and has been reported in severe psoriasis.


This pilot study aimed to clarify whether effective long-term tumor necrosis factor-alfa inhibition decreases IMT in psoriasis.


In 16 patients with severe psoriasis, the Psoriasis Area and Severity Index score was calculated before therapy (etanercept, infliximab, adalimumab) and after 6-month treatment. Simultaneously, carotid and brachial IMT was measured by high-resolution, B-mode ultrasonography. Difference between initial and 6-month IMT values was determined for monitored arteries collectively and separately in carotid and brachial arteries.


All of 16 patients achieved Psoriasis Area and Severity Index 75, and 14 of 16 achieved Psoriasis Area and Severity Index 90 improvement. In the group of patients without initial calcified atherosclerotic plaques (13 of 16) significant IMT decrease was detected when arteries were measured collectively (P  = .0002). Initial and follow-up data differed significantly also at individual analysis of carotid (P  = .011) and brachial (P  = .006) arteries. Eleven of 13 patients had initial carotid IMT exceeding age-adjusted normal values. The other group (3 of 16) with initial manifest plaques showed increasing IMT tendency. Their baseline ultrasonography revealed carotid IMT above the upper limit of healthy adults’ age-adjusted values.


Study limitation involves small patient numbers, self-controlled study design, and lack of patients’ stratification according to common cardiovascular risk factors.


In our pilot study effective tumor necrosis factor-alfa inhibition was found to decrease IMT in psoriatic patients without irreversible atherosclerotic plaques. Further analysis is recommended to confirm and complete our primary observations.

The full text of this article is available in PDF format.

Key words : arterial intima-media thickness, atherosclerosis, cardiovascular risk, high-resolution B-mode ultrasonography, psoriasis vulgaris, tumor necrosis factor-alfa inhibitor

Abbreviations used : CT, FDG, IMT, PASI, PET, TNF, Th

 Funding sources: None.
 Conflicts of interest: None declared.
 Reprints not available from the authors.

© 2013  American Academy of Dermatology, Inc.@@#104156@@
EM-CONSULTE.COM is registrered at the CNIL, déclaration n° 1286925.
As per the Law relating to information storage and personal integrity, you have the right to oppose (art 26 of that law), access (art 34 of that law) and rectify (art 36 of that law) your personal data. You may thus request that your data, should it be inaccurate, incomplete, unclear, outdated, not be used or stored, be corrected, clarified, updated or deleted.
Personal information regarding our website's visitors, including their identity, is confidential.
The owners of this website hereby guarantee to respect the legal confidentiality conditions, applicable in France, and not to disclose this data to third parties.
Article Outline