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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Zoltan Szekanecz, University of Debrecen, Hungary
- Second opponent: Senior Consultant Lotta Ljung, Umeå University, Sweden
- Third member and chair of the evaluation committee: Professor Espen A. Håvardsholm, University of Oslo
Chair of the Defence
Professor Magne Thoresen, University of Oslo
Principal Supervisor
Associate Professor Ivana Hollan, Norwegian University of Technology and Science
Summary
Spondylarthritis (SpA) is associated with an increased risk of cardiovascular disease (CVD). To prevent CVD in SpA patients, it is important to identify the underlying mechanisms that contribute to its development.
This thesis investigates biomarkers that may contribute to the development of CVD in SpA patients. Specifically, we examined complement activation, cholesterol transport markers, and endothelial dysfunction (ED) in SpA patients, and how these parameters changed following antirheumatic treatment.
Our work is based on PSARA, a prospective observational study. Patients were assessed at baseline, after 6 weeks, and after 6 months of anti-rheumatic treatment with tumour necrosis factor-alpha inhibitors (TNFi), or methotrexate.
We found that patients with SpA had increased complement activation compared to reference values, and that levels of activated complement decreased with TNFi treatment. Reduction in complement activation was associated with increased HDL-C, total cholesterol, and improved endothelial function.
Endothelial function was improved in patients with ED who received TNFi, methotrexate, or a combination of these medications, regardless of changes in inflammatory markers.
HDL-C and ApoA1 increased significantly over the treatment period in most patients, while the atherogenic lipoprotein Lp(a) decreased. Despite these changes, cholesterol transport parameters remained largely stable; SR-B1-mediated efflux increased in patients with ankylosing spondylitis, while efflux via ABCG1 and ABCA1, and cholesterol uptake capacity, did not change significantly over the study period.
We conclude that anti-rheumatic treatment is associated with a favourable change in factors associated with an increased risk of CVD. These findings support the importance of adequate treatment of SpA patients, not only to relieve symptoms and prevent joint damage, but also to prevent the cardiovascular comorbidity that is associated with these diseases.
Additional information
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