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. This evidence concerns the gene TNF and endothelial dysfunction.