A recent study found that Janus kinase inhibitors may help reduce early signs of artery damage in patients with rheumatoid arthritis and psoriatic arthritis, although some cardiovascular risks persist.
Researchers followed 48 adults who were treated with Janus kinase inhibitors (JAK inhibitors or JAKi)—baricitinib, upadacitinib, or tofacitinib—for 12 months. Most participants (96%) had rheumatoid arthritis (RA). Together with colleagues, lead author Diana Popescu, of the “Grigore T. Popa” University of Medicine and Pharmacy in Romania, evaluated subclinical atherosclerosis using noninvasive methods such as carotid ultrasound and ankle-brachial index (ABI), alongside blood tests to monitor inflammation and lipid levels.
By the end of the study, the average carotid intima-media thickness (cIMT), an early marker of arterial wall changes, decreased significantly from 0.29 mm to 0.125 mm, which suggested a potential slowing or reversal of early atherosclerotic changes during JAKi therapy.
Systemic inflammation also improved. The proportion of patients with elevated C-reactive protein (CRP) levels declined from 52% at baseline to 37.5% after 12 months. Median CRP levels also dropped from 0.54 mg/dL to 0.25 mg/dL.
Lipoprotein(a) [Lp(a)], a lipid marker that is associated with cardiovascular disease, decreased significantly but remained a consistent predictor of carotid plaque presence at both timepoints. While cIMT improved, carotid plaque prevalence increased modestly from 39.6% to 47.9%, though this increase was not statistically significant.
Traditional risk factors such as hypertension and smoking showed a weaker association with plaque presence after 12 months of treatment. However, Lp(a) continued to correlate with plaque burden, which indicated its importance in ongoing vascular risk.
One of the strongest findings involved ABI, which assesses peripheral artery disease. Patients with low ABI at baseline had a 4.6-fold higher risk of experiencing an acute cardiovascular event during the study period. Therefore, the authors noted using Kaplan-Meier survival curves, preexisting vascular impairment has a long-term influence, even during antiinflammatory treatment.
Participants had a high burden of cardiovascular risk: 75% were over age 50, 58% had hypertension, 75% had elevated BMI, and 17% were smokers. Despite these risks, the researchers observed reductions in inflammation and cIMT, which could point to JAKi's potential vascular effects and the importance of ongoing cardiovascular monitoring.
The findings indicate that while JAK inhibitors may improve early markers of vascular health and reduce systemic inflammation, patients with preexisting arterial damage or elevated Lp(a) remain at elevated cardiovascular risk and may benefit from additional preventive strategies.
The authors reported no conflicts of interest.
Source: Journal of Clinical Medicine
