Previous studies have similarly reported elevated CIMT in r-axSpA patients compared to healthy controls.12,13 Chronic systemic inflammation in r-axSpA, characterized by elevated pro-inflammatory cytokines such as TNF-α and IL-6, accelerates atherosclerosis by promoting endothelial dysfunction and vascular remodeling.14 The reduced Sestrin-1 levels in r-axSpA patients may further exacerbate these processes by impairing oxidative stress regulation and autophagic pathways, both of which are essential for vascular health. Here, TNF is linked to inflammation.