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Dougados M, Serrand C, Alonso S, Berenbaum F, Claudepierre P, Combe B, Gossec L, Ruyssen-Witrand A, Saraux A, Wendling D, Le Querré T, Molto A. Ten-year clinical outcome of recent-onset axial spondyloarthritis: Results from the DESIR inception Cohort. Joint Bone Spine 2024; 91:105678. [PMID: 38163581 DOI: 10.1016/j.jbspin.2023.105678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES This study aimed to evaluate the 10-year clinical outcome of patients with recent-onset axial spondyloarthritis (axSpA). METHODS STUDY DESIGN The DESIR cohort is an inception cohort of axSpA patients. METHODS DIAGNOSIS AND MANAGEMENT The diagnosis and management of patients were based on the decision of the treating rheumatologist. METHODS STATISTICAL ANALYSIS Both complete cases and imputed data analyses were conducted. RESULTS Of the 708 enrolled patients, 45 were excluded due to a change in the baseline diagnosis, 3 patients died, and 300 were lost to follow-up over the 10years. In the completer population, one patient required bilateral total hip replacement, and 56 patients received a pension due to invalidity. The prevalence of main extra-musculoskeletal features increased from baseline to year 10: psoriasis from 18% to 30%, acute anterior uveitis from 10% to 18%, and inflammatory bowel disease from 5% to 10%. The most frequent comorbidity was hypertension, with an increase from 5% to 15% from baseline to year 10. In the imputed data analysis the estimated proportions of patients with an acceptable status at year 10 were 70% [95% CI: 63; 77] for acceptable PASS, 43% [95% CI: 37; 49] for BASDAI<3, and 48% [95% CI: 41; 56] for ASDAS<2.1. CONCLUSION These findings suggest that despite a quite favorable 10-year outcome exists for severe outcomes, a large proportion of patients present with an important disease burden reflected by patient-reported outcomes. This information can be valuable for providing patients with information at the time of diagnosis.
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Affiliation(s)
- Maxime Dougados
- Inserm (U1153), Clinical Epidemiology and Biostatistics, Department of Rheumatology, Hôpital Cochin, Assistance publique-Hôpitaux de Paris, PRES Sorbonne Paris-Cité, University of Paris-Cité, Paris, France
| | - Chris Serrand
- Department of Biostatistics, Epidemiology, Public Health and Methodological Innovation, Nîmes University Hospital, Nîmes, France
| | - Sandrine Alonso
- Department of Biostatistics, Epidemiology, Public Health and Methodological Innovation, Nîmes University Hospital, Nîmes, France
| | - Francis Berenbaum
- Inserm, AP-HP Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - Pascal Claudepierre
- EA 7379-EpiDermE, Service de rhumatologie, AP-HP, Hôpital Henri-Mondor, Université Paris Est Créteil, Paris, France
| | | | - Laure Gossec
- Rheumatology Department, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Adeline Ruyssen-Witrand
- Department of Rheumatology, Toulouse University Hospital, Centre d'investigation clinique de Toulouse CIC1436, Inserm, Paul-Sabatier University Toulouse III, Toulouse, France
| | - Alain Saraux
- Inserm, UMR1227, LabEx IGO, Department of Rheumatology, CHU Brest, Université de Bretagne Occidentale (UBO), Brest, France
| | - Daniel Wendling
- EA4266 EPILAB, Department of Rheumatology, CHU (University Hospital) Besançon, Université de Franche-Comté, Besançon, France
| | - Thierry Le Querré
- Inserm (U1234), Institut de Recherche et d'Innovations Biomédicales, CIC/CRB 1404, Department of Rheumatology, Rouen University, Rouen, France
| | - Anna Molto
- Inserm (U1153), Clinical Epidemiology and Biostatistics, Department of Rheumatology, Hôpital Cochin, Assistance publique-Hôpitaux de Paris, PRES Sorbonne Paris-Cité, University of Paris-Cité, Paris, France.
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Duruöz MT, Bodur H, Ataman Ş, Gürer G, Akgül Ö, Çay HF, Çapkın E, Sezer İ, Rezvani A, Melikoğlu MA, Yağcı İ, Yurdakul FG, Göğüş FN, Kamanlı A, Çevik R, Altan L. Cross-sectional analysis of cardiovascular disease and risk factors in patients with spondyloarthritis: a real-life evidence from biostar nationwide registry. Rheumatol Int 2024; 44:631-642. [PMID: 38319376 PMCID: PMC10914924 DOI: 10.1007/s00296-023-05523-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/20/2023] [Indexed: 02/07/2024]
Abstract
The association between spondyloarthritis and cardiovascular (CV) diseases is complex with variable outcomes. This study aimed to assess the prevalence rates of CV diseases and to analyze the impact of CV risk factors on CV disease in patients with spondyloarthritis. A multi-center cross-sectional study using the BioSTAR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) database was performed on patients with spondyloarthritis. Socio-demographic, laboratory, and clinical data were collected. Patients with and without major adverse cardiovascular events (MACE) were grouped as Group 1 and Group 2. The primary outcome was the overall group's prevalence rates of CV disease and CV risk factors. The secondary outcome was the difference in socio-demographic and clinical characteristics between the groups and predictive risk factors for CV disease. There were 1457 patients with a mean age of 45.7 ± 10.9 years. The prevalence rate for CV disease was 3% (n = 44). The distribution of these diseases was coronary artery disease (n = 42), congestive heart failure (n = 4), peripheral vascular disorders (n = 6), and cerebrovascular events (n = 4). Patients in Group 1 were significantly male (p = 0.014) and older than those in Group 2 (p < 0.001). There were significantly more patients with hypertension, diabetes mellitus, chronic renal failure, dyslipidemia, and malignancy in Group 1 than in Group 2 (p < 0.05). Smoking (36.7%), obesity (24.4%), and hypertension (13.8%) were the most prevalent traditional CV risk factors. Hypertension (HR = 3.147, 95% CI 1.461-6.778, p = 0.003), dyslipidemia (HR = 3.476, 95% CI 1.631-7.406, p = 0.001), and cancer history (HR = 5.852, 95% CI 1.189-28.810, p = 0.030) were the independent predictors for CV disease. A multi-center cross-sectional study using the BioSTAR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) database was performed on patients with spondyloarthritis. Socio-demographic, laboratory, and clinical data were collected. Patients with and without major adverse cardiovascular events (MACE) were grouped as Group 1 and Group 2. The primary outcome was the overall group's prevalence rates of CV disease and CV risk factors. The secondary outcome was the difference in socio-demographic and clinical characteristics between the groups and predictive risk factors for CV disease. There were 1457 patients with a mean age of 45.7 ± 10.9 years. The prevalence rate for CV disease was 3% (n = 44). The distribution of these diseases was coronary artery disease (n = 42), congestive heart failure (n = 4), peripheral vascular disorders (n = 6), and cerebrovascular events (n = 4). Patients in Group 1 were significantly male (p = 0.014) and older than those in Group 2 (p < 0.001). There were significantly more patients with hypertension, diabetes mellitus, chronic renal failure, dyslipidemia, and malignancy in Group 1 than in Group 2 (p < 0.05). Smoking (36.7%), obesity (24.4%), and hypertension (13.8%) were the most prevalent traditional CV risk factors. Hypertension (HR = 3.147, 95% CI 1.461-6.778, p = 0.003), dyslipidemia (HR = 3.476, 95% CI 1.631-7.406, p = 0.001), and cancer history (HR = 5.852, 95% CI 1.189-28.810, p = 0.030) were the independent predictors for CV disease. The prevalence rate of CV disease was 3.0% in patients with spondyloarthritis. Hypertension, dyslipidemia, and cancer history were the independent CV risk factors for CV disease in patients with spondyloarthritis.
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Affiliation(s)
- Mehmet Tuncay Duruöz
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Türkiye.
| | - Hatice Bodur
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Türkiye
| | - Şebnem Ataman
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Ankara University School of Medicine, Ankara, Türkiye
| | - Gülcan Gürer
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, University School of Medicine, Adnan Menderes University, Aydın, Türkiye
| | - Özgür Akgül
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Manisa Celal Bayar University School of Medicine, Manisa, Türkiye
| | - Hasan Fatih Çay
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Antalya Training and Research Hospital, Antalya, Türkiye
| | - Erhan Çapkın
- Department of Physical Medicine and Rehabilitation, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
| | - İlhan Sezer
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, University School of Medicine, Akdeniz University, Antalya, Türkiye
| | - Aylin Rezvani
- Department of Physical Medicine Rehabilitation, Internatonal School of Medicine, İstanbul Medipol University, Istanbul, Türkiye
| | - Meltem Alkan Melikoğlu
- Department of Physical Medicine Rehabilitation, School of Medicine, Atatürk University, Erzurum, Türkiye
| | - İlker Yağcı
- Department of Physical Medicine Rehabilitation, University School of Medicine, Marmara University, Istanbul, Türkiye
| | - Fatma Gül Yurdakul
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, University of Health Sciences, Ankara, Türkiye
| | - Feride Nur Göğüş
- Department of Physical Medicine Rehabilitation and Rheumatology, Gazi University School of Medicine, Ankara, Türkiye
| | - Ayhan Kamanlı
- Department of Physical Medicine Rehabilitation and Rheumatology, School of Medicine, Sakarya University, Sakarya, Türkiye
| | - Remzi Çevik
- Department of Physical Medicine Rehabilitation, School of Medicine, Dicle University, Diyarbakır, Türkiye
| | - Lale Altan
- Department of Physical Medicine Rehabilitation and Rheumatology, School of Medicine, Uludağ University, Bursa, Türkiye
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Zimba O, Gasparyan AY. Cardiovascular issues in rheumatic diseases. Clin Rheumatol 2023; 42:2535-2539. [PMID: 37269421 DOI: 10.1007/s10067-023-06656-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 06/05/2023]
Abstract
Cardiovascular disease is a major cause of morbidity and mortality in rheumatic diseases, particularly rheumatoid arthritis and systemic lupus erythematosus. Timely detection and monitoring of cardiovascular affections by advanced visualization techniques may improve outcomes across most rheumatic diseases. Although high-grade inflammation and (auto)immune pathways are well known for their negative effects on the heart and vasculature, cardiovascular risk estimation remains one of the unresolved critical issues in rheumatic diseases. The issue is complicated further in view of the latest reports on enhanced atherogenesis in the setting of fibromyalgia and osteoarthritis, where inflammation is seemingly not a major pathogenic factor. The intensity of systemic inflammation has been associated with major vascular events in some large cohort studies of inflammatory rheumatic diseases. Experts advocate for tight control of systemic inflammation and modifiable cardiovascular risk factors for reducing the overall risk of vascular events. Increasing patients' and specialists' knowledge and skills in cardiovascular monitoring and prevention is warranted to solve some of the cardiovascular issues in rheumatic diseases. Key Points • Cardiovascular issues are prevalent across all age groups of patients with rheumatic diseases. • Large cohort studies suggest that the intensity of systemic inflammation is a powerful predictor of vascular events in rheumatic diseases. • Reliable and widely tested tools for predicting vascular events in inflammatory rheumatic diseases are currently unavailable. • Empowering patients with rheumatic diseases and first-contact specialists with knowledge and skills to monitor and reduce cardiovascular risk factors' effects is a promising strategy.
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Affiliation(s)
- Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Macieja Jakubowskiego 2, 30-688, Krakow, Poland.
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, UK
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