Effect of TNF alpha inhibitors on atherosclerosis in psoriatic arthritis patients: A Systematic Review Protocol

Psoriatic arthritis (PsA) is a chronic inflammatory condition associated with joint and skin involvement. Cardiovascular disease, particularly atherosclerosis, is a leading cause of morbidity and premature mortality in PsA patients, due to persistent systemic inflammation. Tumor necrosis factor-alpha (TNF-α) inhibitors have proven effective in reducing inflammation in PsA, and some evidence suggests they may also improve vascular health. However, their specific impact on atherosclerosis in PsA remains unclear.

This systematic review aims to evaluate the effect of TNF-α inhibitors on the progression of atherosclerosis in adults with PsA.

This review will follow the PRISMA guidelines. Systematic searches will be conducted in PubMed, Scopus, Embase, and the Cochrane Library using validated search strategies. We will include original observational studies and randomized controlled trials published in English that assess PsA patients treated with TNF-α inhibitors, with comparison groups receiving conventional DMARDs, placebo, or pre-treatment baselines. Studies focusing on direct measures of atherosclerosis or endothelial dysfunction were selected. Reviews, editorials, case reports, and non-English publications will be excluded. Two independent reviewers will conduct the study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale for observational studies and the RoB 2 tool for RCTs. Only high-quality studies will be included. A narrative synthesis will be employed due to expected heterogeneity in study designs and outcomes.