TNF and ischemia: Furthermore, they noted a negative correlation between SIRT1 activity and TNF-α, NF-kB, and other markers, which they interpreted as evidence that SIRT1 exerts an anti-inflammatory effect in rheumatoid arthritis.16 The results suggest that SIRT1 levels are unassociated with BD presence or its activity but may be associated with vascular injury, particularly in the context of chronic complications such as thrombosis, aneurysms, or ischemia, as demonstrated by significantly lower SIRT1 levels in patients with vascular + ocular involvement.