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Qaiyum Z, Seidman MA, Ross HJ, Inman RD. Cardiac valve immune profiling in non-radiographic axial spondyloarthritis. Ann Rheum Dis 2024:ard-2024-225942. [PMID: 38925886 DOI: 10.1136/ard-2024-225942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Zoya Qaiyum
- Schroeder Arthritis Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Michael Aaron Seidman
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Heather Joan Ross
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert D Inman
- Schroeder Arthritis Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Mehdipour Dalivand M, Abdolazimi R, Manafi‐Farid R, Jamshidi A, Kassaee K, Foolad S, Alikhani M. A case of ankylosing spondylitis presenting with fever of unknown origin diagnosed as aortitis: A case report. Clin Case Rep 2023; 11:e8207. [PMID: 38028057 PMCID: PMC10654463 DOI: 10.1002/ccr3.8207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/22/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message Clinicians should be aware of rare manifestations of AS, while considering a low threshold for screening vascular involvement in an axial SpA/nrxSpA/AS presenting with unexplained fevers and significant constitutional symptoms and elevated markers. Abstract Ankylosing spondylitis (AS) is a chronic inflammatory disease from the spondyloarthritis complex, which usually affects young men and primarily involves sacroiliac joints and the spine. It can also present with non-joint involvement, such as cardiovascular manifestations. Aortitis is a rare yet critical cardiovascular complication associated with AS, which can lead to life-threatening outcomes when undiagnosed. Here we report a 34-year-old man with intermittent fevers and significant weight loss, myalgia, and arthralgia for 1 year before being referred to our hospital due to undefinable causes despite multiple diagnostic efforts. The patient presented with elevated inflammatory markers and involvement of sacroiliac joints in favor of the AS. A positron emission tomography scan was also done to rule out underlying malignancy, which led to the detection of inflammation in ascending aorta, compatible with aortitis. The patient was treated with nonsteroidal anti-inflammatory drugs, prednisolone, and infliximab, and his signs and symptoms significantly improved. Our case reports a rare but substantial complication of AS, in a young patient without a history of prolonged disease presenting with unspecific manifestations. The implantation of a thorough examination of AS patients, including cardiac examinations, could contribute to faster and more efficient diagnosis and treatment.
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Affiliation(s)
| | - Rezvan Abdolazimi
- Department of Internal Medicine, Shariati HospitalTehran University of Medical SciencesTehranIran
| | - Reyhaneh Manafi‐Farid
- Research Center for Nuclear Medicine, Shariati HospitalTehran University of Medical SciencesTehranIran
| | - Ahmadreza Jamshidi
- Rheumatology Research Center, Shariati HospitalTehran University of Medical SciencesTehranIran
| | - Kimia Kassaee
- School of MedicineIran University of Medical SciencesTehranIran
| | - Sara Foolad
- College of Agricultural Sciences, Shiraz BranchIslamic Azad UniversityShirazIran
| | - Majid Alikhani
- Rheumatology Research Center, Shariati HospitalTehran University of Medical SciencesTehranIran
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Madenidou AV, Mavrogeni S, Nikiphorou E. Cardiovascular Disease and Cardiac Imaging in Inflammatory Arthritis. Life (Basel) 2023; 13:life13040909. [PMID: 37109438 PMCID: PMC10143346 DOI: 10.3390/life13040909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/01/2023] Open
Abstract
Cardiovascular morbidity and mortality are more prevalent in inflammatory arthritis (IA) compared to the general population. Recognizing the importance of addressing this issue, the European League Against Rheumatism (EULAR) published guidelines on cardiovascular disease (CVD) risk management in IA in 2016, with plans to update going forward based on the latest emerging evidence. Herein we review the latest evidence on cardiovascular disease in IA, taking a focus on rheumatoid arthritis, psoriatic arthritis, and axial spondylarthritis, reflecting on the scale of the problem and imaging modalities to identify disease. Evidence demonstrates that both traditional CVD factors and inflammation contribute to the higher CVD burden. Whereas CVD has decreased with the newer anti-rheumatic treatments currently available, CVD continues to remain an important comorbidity in IA patients calling for prompt screening and management of CVD and related risk factors. Non-invasive cardiovascular imaging has been attracting much attention in view of the possibility of detecting cardiovascular lesions in IA accurately and promptly, even at the pre-clinical stage. We reflect on imaging modalities to screen for CVD in IA and on the important role of rheumatologists and cardiologists working closely together.
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Bhagavathula AS, Bentley BL, Woolf B, Dissanayaka TD, Rahmani J. Increased risk of stroke among patients with ankylosing spondylitis: A systematic review and meta-analysis. REUMATOLOGIA CLINICA 2023; 19:136-142. [PMID: 36906389 DOI: 10.1016/j.reumae.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/28/2022] [Indexed: 03/11/2023]
Abstract
BACKGROUND Ankylosing spondylitis is a chronic inflammatory disease that is associated with adverse cardiovascular events. This study aimed to determine the relationship between ankylosing spondylitis and the risk of stroke. METHODS A systematic literature search in PubMed/MEDLINE, Scopus, and Web of Science were conducted from inception to December 2021 to identify relevant articles investigating the risk of stroke in patients with ankylosing spondylitis. A random-effects model (DerSimonian and Laird) was used to estimate a pooled hazard ratio (HR) and 95% confidence intervals (CI). Meta-regression based on the length of follow-up and subgroup analysis based on the type of stroke, study location, and year of publication to investigate the source of heterogeneity. RESULTS A total of eleven studies comprising 1.7 million participants were included in this study. Pooled analysis showed a significantly increased stroke risk (56%) among patients with ankylosing spondylitis (HR: 1.56, 95% CI 1.33-1.79). Subgroup analysis revealed a higher risk of ischemic stroke among patients with ankylosing spondylitis (HR: 1.46, 95% CI: 1.23-1.68). However, meta-regression analysis showed no association between the duration of ankylosing spondylitis and stroke incidence (Coef=-0.0010, P=0.951). CONCLUSION This study reveals that ankylosing spondylitis was associated with an increased risk of suffering a stroke. Management of cerebrovascular risk factors and the control of systemic inflammation should be considered in patients with ankylosing spondylitis.
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Affiliation(s)
- Akshaya Srikanth Bhagavathula
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy at Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Barry L Bentley
- Cardiff School of Technologies, Cardiff Metropolitan University, Cardiff, UK; Collaboration for the Advancement of Sustainable Medical Innovation, University College London, London, UK
| | - Benjamin Woolf
- Department of Psychological Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Thusharika D Dissanayaka
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka; Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Jamal Rahmani
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Choi E, Mathews LM, Paik J, Corretti MC, Wu KC, Michos ED, Hays AG, Mukherjee M. Multimodality Evaluation of Aortic Insufficiency and Aortitis in Rheumatologic Diseases. Front Cardiovasc Med 2022; 9:874242. [PMID: 35497991 PMCID: PMC9039512 DOI: 10.3389/fcvm.2022.874242] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/21/2022] [Indexed: 12/17/2022] Open
Abstract
Aortic insufficiency is commonly observed in rheumatologic diseases such as ankylosing spondylitis, systemic lupus erythematosus, antiphospholipid syndrome, Behçet's disease, granulomatosis with polyangiitis, and Takayasu arteritis. Aortic insufficiency with an underlying rheumatologic disease may be caused by a primary valve pathology (leaflet destruction, prolapse or restriction), annular dilatation due to associated aortitis or a combination of both. Early recognition of characteristic valve and aorta morphology on cardiac imaging has both diagnostic and prognostic importance. Currently, echocardiography remains the primary diagnostic tool for aortic insufficiency. Complementary use of computed tomography, cardiac magnetic resonance imaging and positron emission tomography in these systemic conditions may augment the assessment of underlying mechanism, disease severity and identification of relevant non-valvular/extracardiac pathology. We aim to review common rheumatologic diseases associated with aortic insufficiency and describe their imaging findings that have been reported in the literature.
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Affiliation(s)
- Eunjung Choi
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH, United States
| | - Lena M. Mathews
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Julie Paik
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, United States
| | - Mary C. Corretti
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine C. Wu
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Allison G. Hays
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
- *Correspondence: Monica Mukherjee
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Kao CM, Wang JS, Ho WL, Ko TM, Chen HM, Lin CH, Huang WN, Chen YH, Chen HH. Factors Associated with the Risk of Major Adverse Cardiovascular Events in Patients with Ankylosing Spondylitis: A Nationwide, Population-Based Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074098. [PMID: 35409780 PMCID: PMC8998897 DOI: 10.3390/ijerph19074098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 01/27/2023]
Abstract
Background: Potential risk factors for major adverse cardiovascular events (MACE) in patients with ankylosing spondylitis (AS) requiring medical therapy should be investigated. Methods: We identified newly diagnosed AS patients without previous MACE from 2004 to 2012 using the National Health Insurance Research Database, matched MACE cases with non-MACE controls at a 1:4 ratio for age, gender, AS duration, and index date, and included 947 AS patients with MACE and 3896 matched controls for final analyses. By using conditional logistic regression analyses, we examined the associations of MACE with low income, urbanisation, comorbidities, common extra-articular manifestations (EAM), and medications, including nonsteroidal anti-inflammatory drugs (NSAID) of three categories (traditional NSAIDs, selective cyclooxygenase-2 inhibitors (COX-2i), and preferential COX-2is) with their annual cumulative defined daily dose (cDDD) within a year before MACE development. Results: MACE development was associated with the use of selective COX-2is (especially with annual cDDD > 132) and corticosteroids, residence in rural regions, and well-known associated comorbidities, but not with the use of traditional NSAIDs, preferential COX-2i, biologics, methotrexate, sulfasalazine, and common EAMs. Conclusions: The risk factors of MACE in newly diagnosed AS patients include residence in rural regions, well-known associated comorbidities, and the use of corticosteroids and selective COX-2is. A major limitation was the lack of information on individual lifestyle patterns and disease activity.
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Affiliation(s)
- Chung-Mao Kao
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-M.K.); (W.-N.H.); (Y.-H.C.)
| | - Jun-Sing Wang
- Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Wei-Li Ho
- Division of Allergy, Immunology and Rheumatology, Chiayi Branch, Taichung Veterans General Hospital, Chiayi 60090, Taiwan;
| | - Tai-Ming Ko
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan;
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
| | - Hsian-Min Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (H.-M.C.); (C.-H.L.)
- Center for QUantitative Imaging in Medicine (CQUIM), Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Computer Science and Information Engineering, National United University, Miaoli 36063, Taiwan
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (H.-M.C.); (C.-H.L.)
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 40704, Taiwan
- Department of Healthcare Management, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Wen-Nan Huang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-M.K.); (W.-N.H.); (Y.-H.C.)
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-M.K.); (W.-N.H.); (Y.-H.C.)
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-M.K.); (W.-N.H.); (Y.-H.C.)
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 40704, Taiwan
- Division of General Internal Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Big Data Center, National Chung Hsing University, Taichung 40227, Taiwan
- Correspondence:
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Min HK, Kim HR, Lee SH, Park S, Park M, Hong YS, Kim MY, Park SH, Kang KY. Increased risks of aortic regurgitation and atrial fibrillation in radiographic axial spondyloarthritis patients: a 10-year nationwide cohort study. Ther Adv Musculoskelet Dis 2022; 14:1759720X221088094. [PMID: 35368372 PMCID: PMC8972938 DOI: 10.1177/1759720x221088094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background: To compare the incidences of aortic regurgitation, atrial fibrillation (AF), and atrioventricular (AV) block II–III between radiographic axial spondyloarthritis (r-axSpA) patients and the general population (GP). Methods: National Health Insurance Services data were used. R-axSpA patients (N = 8877) and the age- and sex-matched GP (N = 26,631) were followed from August 2006 to December 2019. Incidence rates and standardized incidence ratios (SIRs) of aortic regurgitation, AF, and AV block II–III were compared between these groups. Ten-year incidence rates and hazard ratios (HRs) were calculated by the Kaplan–Meier method and Cox regression analysis. Results: Incidence rates of aortic regurgitation, AV block II–III, and AF in the r-axSpA group were 0.42, 0.21, and 4.0 per 1000 person-years (PYs), respectively. In the r-axSpA group, the SIR for aortic regurgitation was highest among 40- to 49-year-old men (4.11). Incidence rates of aortic regurgitation and AF were higher in the r-axSpA group than in the GP group (0.42 versus 0.18 per 1000 PYs 4.00 versus 3.13 per 1000 PYs, both p < 0.001, respectively), whereas the difference was insignificant for AV block II–III (0.21 versus 0.14 per 1000 PYs, p = 0.222). In multivariate analysis, r-axSpA was associated with a higher hazard (risk) for the development of aortic regurgitation and AF [HR (95% confidence interval) = 2.55 (1.49–4.37) and 1.20 (1.04–1.39), respectively], but the difference was insignificant for AV block II–III [HR (95% confidence interval) = 1.17 (0.59–2.31)]. Conclusions: Compared with the GP, r-axSpA patients are at increased risk of aortic regurgitation and AF, but not AV block II–III. These patients should be carefully monitored for occurrence of aortic regurgitation and AF.
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Affiliation(s)
- Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Sang-Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Sojeong Park
- Data Science Team, Hanmi Pharmaceuticals Co., Ltd., Seoul, South Korea
| | - Minae Park
- Data Science Team, Hanmi Pharmaceuticals Co., Ltd., Seoul, South Korea
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Moon-Young Kim
- Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, #56 Dongsu-Ro, Bupyung-Gu, Incheon KS006, South Korea
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul KS013, South Korea
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Romand X, Adeline F, Dalecky M, Pflimlin A, Bellier A, Barone-Rochette G, Wendling D, Gaudin P, Claudepierre P, Dougados M, Baillet A. Systematic assessment of heart valves and cardiac function by echocardiography in axial spondyloarthritis: a systematic review and meta-analysis. Joint Bone Spine 2022; 89:105375. [DOI: 10.1016/j.jbspin.2022.105375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
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Aortic root diameter is associated with HLA-B27: identifying the patient with ankylosing spondylitis at risk for aortic valve regurgitation. Rheumatol Int 2021; 42:683-688. [PMID: 34729637 PMCID: PMC8940876 DOI: 10.1007/s00296-021-05040-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/22/2021] [Indexed: 11/29/2022]
Abstract
To assess the association between the aortic root diameter in HLA-B27 positive (+) and HLA-B27 negative (−) ankylosing spondylitis (AS) patients from the CARDAS cohort. The CARDAS study is a cross-sectional study in AS patients between 50 and 75 years who were recruited from a large rheumatology outpatient clinic. Patients underwent cardiovascular screening including echocardiography, with 2D, spectral, and color flow Doppler measurements. The aortic root was measured at sinuses of Valsalva during diastole. The aortic root diameter was adjusted for body surface area (BSA) (aortic root index, cm/m2). 193 Consecutive AS patients were included of whom 158 (82%) were HLA-B27 positive. The aortic root index was significantly higher in HLA-B27 + patients compared to HLA-B27− patients, respectively, 1.76 cm ± 0.21 vs. 1.64 cm ± 0.14, p < 0.001. No difference was seen in the prevalence of aortic valve regurgitation (AVR), p = 0.8. Regression analysis showed a significant association between HLA-B27 and aortic root index corrected for age, sex and cardiovascular risk factors (β 0.091, 95% CI 0.015–0.168, p = 0.02). Especially, male HLA-B27 + patients had a significantly increased aortic root index compared to male HLA-B27− AS patients, respectively, 1.76 cm (1.63–1.88) and 1.59 cm (1.53–1.68), p < 0.001. We found an increased aortic root index in elderly HLA-B27 + AS patients compared to HLA-B27− AS patients, especially in male patients. No difference was seen in the prevalence of AVR. However, as AVR can be progressive, echocardiographic monitoring in elderly male HLA-B27 + AS might be considered.
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The Prevalence of Cardiac Diseases in a Contemporary Large Cohort of Dutch Elderly Ankylosing Spondylitis Patients-The CARDAS Study. J Clin Med 2021; 10:jcm10215069. [PMID: 34768587 PMCID: PMC8584336 DOI: 10.3390/jcm10215069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 01/05/2023] Open
Abstract
Objectives: The aim of the present study was to determine the prevalence of specific cardiac manifestations, i.e., conduction disorders, valvular disease and diastolic left ventricular (LV) dysfunction, in a large cross-sectional controlled cohort of elderly ankylosing spondylitis (AS) patients. Methods: This cross-sectional study assessed the prevalence of valvular disease, conduction disorders and LV dysfunction in 193 randomly selected AS patients compared with 74 osteoarthritis (OA) controls aged 50–75 years. Patients underwent conventional and tissue Doppler echocardiography in combination with clinical and laboratory assessments. Multivariate regression analyses were performed to compare the odds of mitral valve regurgitation (MVR) and aortic valve regurgitation (AVR) between AS patients and OA controls. Results: The prevalence of diastolic dysfunction was trivial and comparable in AS patients compared to controls (respectively, 4% and 3%) and had no further clinical relevance. In addition, the prevalence of conduction disturbances was similar in both groups, with little clinical relevance, respectively 23% vs. 24%. The prevalence of AVR was significantly higher in AS patients compared to the controls, respectively 23% (9% trace, 12% mild, 1% moderate, 1% severe, 1% prosthesis) vs. 11%, p = 0.04. After correcting for age, sex and CV risk factors, AS patients had an odds ratio of 4.5 (95% CI 1.1–13.6) for AVR compared to the controls. In contrast, the prevalence values of MVR were similar and mostly not clinically relevant in AS patients and controls, respectively 36% and 32% and p = 0.46. Conclusion: The prevalence of diastolic LV dysfunction and conduction disorders was mostly not clinically relevant, and similar in AS patients and controls. However, AS patients had an up to five times increased odds to develop AVR compared to controls. Therefore, echocardiographic screening of elderly (50–75 years) AS patients should be considered.
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Park HS, Laiz A, Sanchez-Vega J, Díaz Del Campo P, Martín-Martínez MA, Guerra-Rodríguez M, Corominas H. Valve Abnormalities, Risk Factors for Heart Valve Disease and Valve Replacement Surgery in Spondyloarthritis. A Systematic Review of the Literature. Front Cardiovasc Med 2021; 8:719523. [PMID: 34631824 PMCID: PMC8498574 DOI: 10.3389/fcvm.2021.719523] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022] Open
Abstract
Objective: Evaluate the evidence on the abnormalities of the aortic root and heart valves, risk and prognostic factors for heart valve disease and valve replacement surgery in spondyloarthritis. Methods: A systematic literature review was performed using Medline, EMBASE and Cochrane databases until July 2021. Prevalence, incidence, risk and prognostic factors for heart valve disease; dimension, morphology, and pathological abnormalities of the valves were analyzed. Patient characteristics (younger age, history of cardiac disease or longer disease duration) and period of realization were considered for the analysis. The SIGN Approach was used for rating the quality of the evidence of the studies. Results: In total, 37 out of 555 studies were included. Overall, the level of evidence was low. The incidence of aortic insufficiency was 2.5–3.9‰. Hazard Ratio for aortic insufficiency was 1.8–2.0. Relative risk for aortic valve replacement surgery in ankylosing spondylitis patients was 1.22–1.46. Odds ratio for aortic insufficiency was 1.07 for age and 1.05 for disease duration. Mitral valve abnormalities described were mitral valve prolapse, calcification, and thickening. Aortic valve abnormalities described were calcification, thickening and an echocardiographic “subaortic bump.” Abnormalities of the aorta described were thickening of the wall and aortic root dilatation. The most common microscopic findings were scarring of the adventitia, lymphocytic infiltration, and intimal proliferation. Conclusions: A higher prevalence and risk of aortic valve disease is observed in patients with ankylosing spondylitis. Studies were heterogeneous and analysis was not adjusted by potential confounders. Most studies did not define accurate outcomes and may have detected small effects as being statistically significant.
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Affiliation(s)
- Hye-Sang Park
- Rheumatology Department, Hospital Dos de Maig, Barcelona, Spain
| | - Ana Laiz
- Rheumatology and Autoimmune Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jesus Sanchez-Vega
- Cardiology Department, Hospital Universitari Bellvitge, Hospitalet de Llobregat, Spain.,Department of Medicine, Universitat de Barcelona (UB), Barcelona, Spain
| | | | | | | | - Hector Corominas
- Rheumatology Department, Hospital Dos de Maig, Barcelona, Spain.,Rheumatology and Autoimmune Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Eddarami J, Azzouzi H, Ichchou L. Heart Involvement in a Moroccan Population with Spondyloarthritis: A Cross-sectional Study. J Saudi Heart Assoc 2021; 33:191-197. [PMID: 34307015 PMCID: PMC8294134 DOI: 10.37616/2212-5043.1258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 01/31/2023] Open
Abstract
Objectives The aim of this study was to investigate the prevalence of cardiac manifestations and their predictive factors in Moroccan patients with spondyloarthritis (SpA). Methods We have conducted a cross-sectional study over four months at the Department of Rheumatology in Mohammed VI University Hospital of Oujda, Morocco. All SpA patients fulfilled the 2009 Assessment SpondyloArthritis international Society (ASAS) criteria. Every patient had a cardiac check up including clinical examination, 12-lead electrocardiogram (ECG) and transthoracic echocardiography (TTE). Multiple logistic regression was used to analyze the associated factors with cardiac manifestations. Results We included 64 men and 30 women with a mean age of 37.32 ± 12.65 years old. The mean disease duration was 10.60 ± 7.61 years. Patients had a mean Ankylosing Spondylitis Disease Activity Score (ASDAS) CRP of 2.25 ± 1.38, a mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of 2.88 ± 2.26 and a mean Bath Ankylosing Spondylitis Functional Index (BASFI) of 33.52 ± 30.49. Traditional cardiovascular risk factors (CVRF) included dyslipidemia in 14.9%, hypertension in 9.6% and type 2 diabetes in 7.4% of the cases. Eight patients (8.5%) smoked and 3 patients (3.2%) used alcohol whereas 20 patients (21.3%) had a history of smoking and 5 patients (6.3%) a history of alcohol. Cardiac manifestations were found in 12 patients (13.3%): 3.3% had aortic regurgitation (AR), 1.1% had aortic dilatation, 1.1% had aortic valve thickening (AVT), 2.2% had mitral thickening, 1.1% had mitral regurgitation (MR), 1.1% had mitral stenosis (MS), 3.3 had pericarditis and 2.2% had complete right bundle branch block (RBBB). In multivariate analysis, cardiac involvement was significantly associated with extra-articular manifestations (OR = 6.05; 95% CI: 1.197-30.607, p = 0.029). Conclusion Based on these results, cardiac involvement was common and associated with the severity of the disease; hence, early detection of cardiac abnormalities and targeted treatment strategies of SpA and comorbidities are necessary to control the systemic inflammation and improve the excess of cardiovascular mortality in this group of patients.
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Affiliation(s)
- Jalila Eddarami
- Department of Rheumatology, Mohamed VI University Hospital, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
| | - Hamida Azzouzi
- Department of Rheumatology, Mohamed VI University Hospital, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
| | - Linda Ichchou
- Department of Rheumatology, Mohamed VI University Hospital, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
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13
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Siao WZ, Liu CH, Wang YH, Wei JCC, Jong GP. Increased risk of valvular heart disease in patients with ankylosing spondylitis: a nationwide population-based longitudinal cohort study. Ther Adv Musculoskelet Dis 2021; 13:1759720X211021676. [PMID: 34211590 PMCID: PMC8216336 DOI: 10.1177/1759720x211021676] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/11/2021] [Indexed: 01/19/2023] Open
Abstract
Aims: We aimed to evaluate the risk of valvular heart disease (VHD) among patients with ankylosing spondylitis (AS). Methods: This was a population-based cohort study utilizing the Longitudinal Health Insurance Research Database of the National Health Insurance in Taiwan. Patients with and without coding of newly diagnosed AS from 1999 to 2013 were assigned to the AS and non-AS groups, respectively. Primary outcome was the incidental risk of VHD. Multiple Cox regression was used to estimate the adjusted hazard ratio of VHD. Subgroup analysis and sensitivity tests were also conducted. Results: The AS group included 3780 patients, and 22,680 matched subjects without an AS diagnosis were identified as controls. The AS group had an increased risk of VHD compared with non-AS controls (adjusted hazard ratio: 1.63; 95% confidence interval: 1.43–1.86; p < 0.001). Subgroup analysis also revealed an increased risk of individual types of VHD, including aortic, mitral, and tricuspid valve disease. Patients in the AS group had a higher incidence of valve replacement surgery after the onset of VHD. Conclusion: Patients with AS had a significant risk of VHD compared to non-AS controls in this population-based cohort study. Screening for VHD may be needed in caring patients with AS. We suggest that echocardiography may be performed when patients are diagnosed with AS.
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Affiliation(s)
- Wun-Zhih Siao
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung
| | - Chin-Hsiu Liu
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung
| | - Gwo-Ping Jong
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital and Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Road, Taichung, 40201
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14
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Almasi S, Farahani B, Samiei N, Rezaei Y, Mahmoodi H, Qorbani M. Echocardiographic and Electrocardiographic Findings in Patients with Ankylosing Spondylitis without Cardiovascular Risk Factors. J Tehran Heart Cent 2021; 15:43-49. [PMID: 33552193 PMCID: PMC7825462 DOI: 10.18502/jthc.v15i2.4182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Ankylosing spondylitis (AS) is a chronic inflammatory condition associated with more cardiac manifestations than those in the normal population. In this study, we sought to determine the prevalence of cardiac involvement in patients suffering from AS without cardiovascular risk factors. Methods: The present case-control study, conducted in 2 university hospitals in Tehran from January 2016 to December 2017, recruited 67 patients with AS and 40 age- and sex-matched healthy controls. The diagnosis of AS was based on the classification criteria of the Assessment of SpondyloArthritis International Society. All the participants were examined using transthoracic echocardiography and a standard 12-lead ECG. Baseline characteristics, echocardiographic findings, and ECG features were compared between the AS and control groups using univariate analyses. Results: The median age was 33.5 (IQR25-75%: 20.5–59) years in the AS group and 35 (IQR25-75%: 26–59) years in the control group (P=0.301). The number of patients with left ventricular systolic and diastolic dysfunction was significantly higher in the patients with AS than in the controls (7.5% vs. 20.9%; P=0.067, and 22.9% vs. 5.0%; P=0.026, respectively). The number of individuals with a left-axis deviation and a left anterior fascicular block was significantly higher in the patients suffering from AS than in the control group. The number of patients with aortic valve involvement was comparable between the groups (P=0.332). Conclusion: The most common cardiac involvement in our patients with AS was left ventricular dysfunction, followed by rhythm disturbances and aortic valve insufficiency. These findings were independent of age, AS severity, and disease duration. Therefore, the implementation of cardiovascular screening can be recommended for patients with AS.
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Affiliation(s)
- Simin Almasi
- Rheumatology Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Behzad Farahani
- Department of Cardiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Samiei
- Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Rezaei
- Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Habib Mahmoodi
- Department of Internal Medicine, Firoozgar Hospital, Iran University of Medical Sciences , Tehran, Iran
| | - Mostafa Qorbani
- Department of Public Health, Alborz University of Medical Sciences, Karaj, Iran.,Noncommunicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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15
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Multimodality Imaging of Aortic Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00831-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Abstract
PURPOSE OF REVIEW Cardiac involvement in patients with ankylosing spondylitis (AS) generally manifests itself as aortic insufficiency, aortitis, disturbance in cardiac conduction, and myocardial dysfunction. We have used a case-based approach to review the current state of the art knowledge regarding the diagnosis and management of aortic valve disease and aortitis in patients with AS. RECENT FINDINGS The risk for aortic valve disease and aortic valve replacement or repair is significantly higher than in people without AS, and this risk increases with age. Echocardiography, cardiac MRI, and CT can serve as effective tools for screening and follow-up. Surgical repair/replacement remains the mainstay of therapy for aortic insufficiency and aortic dilation, whereas transcatheter-based techniques may be favorable in the setting of aortic stenosis. Aortic valve and atrioventricular conduction abnormalities contribute to overall cardiovascular burden in AS. Optimal timing and therapeutic technique are dependent on assessment of overall risk and serial follow-up.
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17
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Lo Gullo A, Rodríguez-Carrio J, Gallizzi R, Imbalzano E, Squadrito G, Mandraffino G. Speckle tracking echocardiography as a new diagnostic tool for an assessment of cardiovascular disease in rheumatic patients. Prog Cardiovasc Dis 2020; 63:327-340. [PMID: 32201285 DOI: 10.1016/j.pcad.2020.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/08/2020] [Indexed: 12/30/2022]
Abstract
Chronic inflammation represents the cornerstone of the raised cardiovascular (CV) risk in patients with inflammatory rheumatic diseases (IRD). Standardized mortality ratios are increased in these patients compared to the general population, which can be explained by premature mortality associated with early atherosclerotic events. Thus, IRD patients need appropriate CV risk management in view of this CV disease (CVD) burden. Currently, optimal CV risk management is still lacking in usual care, and early diagnosis of silent and subclinical CVD involvement is mandatory to improve the long-term prognosis of those patients. Although CV involvement in such patients is highly heterogeneous and may affect various structures of the heart, it can now be diagnosed earlier and promptly treated. CV imaging provides valuable information as a reliable diagnostic tool. Currently, different techniques are employed to evaluate CV risk, including transthoracic or trans-esophageal echocardiography, magnetic resonance imaging, or computed tomography, to investigate valve abnormalities, pericardial disease, and ventricular wall motion defects. All the above methods are reliable in investigating CV involvement, but more recently, Speckle Tracking Echocardiography (STE) has been suggested to be diagnostically more accurate. In recent years, the role of left ventricular ejection fraction (LVEF) as the gold standard parameter for the evaluation of systolic function has been debated, and many efforts have been focused on the clinical validation of new non-invasive tools for the study of myocardial contractility as well as to characterize the subclinical alterations of the myocardial function. Improvement in the accuracy of STE has resulted in a large amount of research showing the ability of STE to overcome LVEF limitations in the majority of primary and secondary heart diseases. This review summarizes the additional value that STE measurement can provide in the setting of IRD, with a focus in the different clinical stages.
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Affiliation(s)
- Alberto Lo Gullo
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, 98122, Italy; IRCCS Neurolesi Bonino-Pulejo, Piemonte Hospital, 98100, Italy
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Faculty of Medicine, University of Oviedo, Oviedo 33006, Spain; Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Oviedo 33011, Spain; Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación Nefrológica, REDinREN Del ISCIII, Hospital Universitario Central de Asturias, Oviedo 33011, Spain.
| | - Romina Gallizzi
- Unit of Pediatrics, Department of Human Pathology in Adulthood and Childhood, University of Messina, 98122
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, 98122, Italy
| | - Giovanni Squadrito
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, 98122, Italy
| | - Giuseppe Mandraffino
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, 98122, Italy
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18
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Ankylosing Spondyloarthritis Resulting Severe Aortic Insufficiency and Aortitis: Exacerbation of Ankylosing Spondyloarthritis and Stenosis of the Main Left Coronary Artery after Mechanical Aortic Valve Implantation with Cardiopulmonary Bypass. Case Rep Rheumatol 2020; 2020:9538527. [PMID: 31984147 PMCID: PMC6964718 DOI: 10.1155/2020/9538527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/17/2019] [Indexed: 12/03/2022] Open
Abstract
Ankylosing spondyloarthritis (AS) is a chronic inflammatory rheumatic disease, strongly related to human leukocyte antigen (HLA)-B27. Cardiac involvement in AS manifests in 2 to 10% of patients as aortic insufficiency, aortitis, mitral valve fibrosis, or disturbance in the conduction of the heart. In this article, we present a case of a 49-year-old male patient with AS, who was referred to our medical institution for elective aortic valve surgery because of severe aortic regurgitation. The histological findings revealed fibrosing endocarditis of aortic valve and nonspecific aortitis of aortic root. Late postoperatively, we observed exacerbation of AS and narrowing of the main left coronary artery (LAD). Our case highlights the importance of proper treatment of AS before and after cardiac surgery. Furthermore, in this case, we suspect association between cardiopulmonary bypass, activity of AS, and coronary artery disease.
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19
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Min HK, Lee J, Ju JH, Kwok SK, Youn HJ, Park SH. Echocardiographic Evaluation of Axial Spondyloarthritis in Korea: Data From the Catholic Axial Spondyloarthritis Cohort. JOURNAL OF RHEUMATIC DISEASES 2020. [DOI: 10.4078/jrd.2020.27.1.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Jennifer Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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20
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Abstract
The term inflammatory joint disease (IJD) encompasses a group of chronic conditions with predominant joint involvement. They share an increased risk of cardiovascular (CV) complications. However, the implication of the sex in the risk of CV disease in IJD has not been specifically addressed. The aim of this work is to assess the influence of sex on the clinical expression of CV manifestations associated to IJD. With this objective, an update of the current knowledge of the sex influence on CV disease in patients with IJD was conducted. A PubMed database search of the most relevant literature on this topic was performed mainly based on studies published in English over the last 10 years. Although most studies on IJD were not specifically designed to address sex differences regarding CV complications, it seems that men with rheumatoid arthritis (RA) are at higher risk of pericarditis, ischemic heart disease, heart failure (HF) with reduced ejection fraction (EF), and CV mortality than women with RA. In contrast, HF with preserved EF and diastolic dysfunction is more frequent in women with RA. Men with ankylosing spondylitis present more frequently disorders of the conduction system and aortic valvulopathy than women. A limited number of studies addressed CV differences according to sex in psoriatic arthritis. Although there are some differences according to sex in the clinical expression of CV complications in patients with IJD, much research is still needed to better identify the implication of sex in the risk of CV disease in these patients.
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21
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Bengtsson K, Klingberg E, Deminger A, Wallberg H, Jacobsson LTH, Bergfeldt L, Forsblad-d'Elia H. Cardiac conduction disturbances in patients with ankylosing spondylitis: results from a 5-year follow-up cohort study. RMD Open 2019; 5:e001053. [PMID: 31798955 PMCID: PMC6861087 DOI: 10.1136/rmdopen-2019-001053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/27/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
Objectives To describe electrocardiographic (ECG) development in patients with ankylosing spondylitis (AS) and identify associations between baseline characteristics and cardiac conduction disturbances (CCD) at 5-year follow-up. Methods In a longitudinal cohort study, 172 patients (54% men, mean age (SD) of 50 (13) years at baseline) with AS underwent ECG, physical examination, questionnaires and laboratory testing at baseline and at 5-year follow-up. Descriptive statistics and univariate and age- and sex-adjusted logistic regression analyses were used. CCD included both atrioventricular and intraventricular blocks. Results Twenty-three of the 172 patients (13.4%) had a CCD at follow-up. Eight patients had developed a new CCD and eight had normalised their ECG. In the age- and sex-adjusted analyses, CCD at baseline (OR 24.8, 95% CI 7.3 to 84.5), male sex (OR 6.4, 95% CI 2.0 to 20.8), history of anterior uveitis (OR 4.4, 95% CI 1.3 to 14.5), higher ASDAS-CRP (OR 2.3, 95% CI 1.3 to 4.0), greater waist circumference (OR 1.3, 95% CI 1.1 to 1.6, per 5 cm), and medication with antiplatelets (OR 7.0, 95% CI 1.5 to 31.8) and beta-blockers (OR 3.4, 95% CI 1.0 to 11.5) were associated with a CCD at follow-up. Higher age and longer symptom duration were highly correlated and were both associated with a CCD at follow-up. Conclusions The presence of CCD in AS is in part dynamic and associated with both AS and non-AS characteristics. Our results suggest that patients especially prone to present with CCDs are older men with a previous CCD, longer symptom duration, higher AS disease activity, a history of anterior uveitis and medication reflecting cardiovascular disease.
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Affiliation(s)
- Karin Bengtsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology, Sahlgrenska University Hospital, Västra Götalandsregionen, Gothenburg, Sweden
| | - Eva Klingberg
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology, Sahlgrenska University Hospital, Västra Götalandsregionen, Gothenburg, Sweden
| | - Anna Deminger
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology, Sahlgrenska University Hospital, Västra Götalandsregionen, Gothenburg, Sweden
| | - Hanna Wallberg
- Department of Anesthesiology and Intensive Care, NU Hospital Group, Västra Götalandsregionen, Trollhättan, Sweden
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology, Sahlgrenska University Hospital, Västra Götalandsregionen, Gothenburg, Sweden
| | - Lennart Bergfeldt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Västra Götalandsregionen, Gothenburg, Sweden
| | - Helena Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
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22
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Abstract
Background The likelihoods of valvular heart disease ( VHD ) and conduction abnormalities in patients with ankylosing spondylitis ( AS p) are poorly defined. Knowing their lifetime risks of VHD and pacemaker use would help inform whether cardiac screening should be done. Methods and Results Patients with AS p and a comparison group without AS p were identified among US Medicare beneficiaries in 1999 to 2013. Frequencies of VHD and pacemaker use were compared in 4 age groups: 65 to 69 years, 70 to 74 years, 75 to 79 years, and 80 years or older, as were rates of valve surgeries, a measure of VHD severity, and new pacemaker insertions. Outcomes were compared between 42 327 patients with AS p and 19 211 703 patients without AS p. The prevalence of aortic valve disease in patients with AS p increased with age (2.6%, 6.7%, 10.9%, and 17.1%), as did the prevalence of mitral valve disease. Risks of VHD were slightly but significantly higher in patients with AS p (adjusted odds ratios 1.06-1.51). Rates of aortic valve replacement/repair were also higher in patients with AS p than in the comparison group (125 versus 93; 183 versus 149; 261 versus 208; 279 versus 191 per 100 000 patient-years in the 4 age groups). Rates of mitral valve surgery did not differ between groups. Among patients with AS p, pacemaker use ranged from 1.0% to 7.6% across age groups, and was slightly higher than in controls (odds ratio range 1.11-1.32). Conclusions Lifetime risks of VHD and pacemaker use in AS p increase markedly with age, but are only slightly higher than in elderly people without AS p.
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Affiliation(s)
- Michael M Ward
- 1 Intramural Research Program National Institute of Arthritis and Musculoskeletal and Skin Diseases National Institutes of Health Bethesda MD
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23
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Yan S, Cui Y, Zhang X, Zhang G, Dong G, Feng Y, Song Y. The incidence of extra-articular manifestations in southern Chinese patients with inflammatory joint diseases. Int J Rheum Dis 2019; 22:1686-1694. [PMID: 31328410 DOI: 10.1111/1756-185x.13657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/17/2019] [Accepted: 06/23/2019] [Indexed: 02/05/2023]
Abstract
AIM Inflammatory joint diseases (IJDs) are chronic arthritis, but frequently present with co-morbidities of other organs and systems, which is known as extra-articular manifestations (EAMs). It is still unclear which clinical characteristics or bio-markers can predict the development of EAMs. The aim of this study was to estimate the proportion of EAMs in southern Chinese patients with IJDs and to explore the risk factors. METHODS This was a retrospective cohort study of a total 1135 IJDs patients, including 788 rheumatoid arthritis (RA) patients, 307 ankylosing spondylitis (AS) patients and 40 psoriatic arthritis (PsA) patients. Demographic data, disease characteristics, laboratory blood tests, medical imaging, and the presence of EAMs were recorded. RESULTS We found 459 (40.44%) patients presented with EAMs: 30.84% had cardiovascular involvement, 7.67% had pulmonary involvement, 5.29% had osteoporosis/low bone mineral density, 2.29% had ocular, 0.79% had gastrointestinal and 0.26% had renal involvements. Multivariate logistic regression showed older age (odds ratio [OR] 1.06, P < .001) and higher anti-cyclic citrullinated peptide antibody (anti-CCP) levels (OR 1.003, P = .019) were independent risks of EAMs in RA patients. In the AS group, older age (OR 1.07, P < .001) and higher disease activity (OR 3.24-7.42, both P < .05), were independent risks of EAMs. In the PsA group, longer disease duration (OR 1.01, P = .036) and higher disease activity (OR 1.15, P = .004) were univariate associated factors. CONCLUSION These results suggested the high prevalence of EAMs, and it is important to regularly screen for EAMs, as they influence treatment decisions and impact on patients' quality of life.
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Affiliation(s)
- Siyu Yan
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Yang Cui
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Xiao Zhang
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Guangfeng Zhang
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Guangfu Dong
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Yuan Feng
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Yingyu Song
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, Guangzhou, China
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Midtbø H, Semb AG, Matre K, Rollefstad S, Berg IJ, Gerdts E. Left Ventricular Systolic Myocardial Function in Ankylosing Spondylitis. Arthritis Care Res (Hoboken) 2019; 71:1276-1283. [PMID: 30242984 DOI: 10.1002/acr.23765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/18/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Subclinical left ventricular (LV) myocardial dysfunction is associated with an increased risk of cardiovascular disease (CVD), but it is not known whether subclinical LV myocardial dysfunction is present in patients with ankylosing spondylitis (AS) independent of CVD risk factors. METHODS Conventional and speckle tracking echocardiography were performed in 106 patients with AS (mean ± SD age 48 ± 12 years; 59% men) and 106 matched controls (mean ± SD age 51 ± 12 years; 59% men). LV systolic myocardial function was assessed by peak systolic global longitudinal strain (GLS). RESULTS CVD risk factors were similarly distributed in patients with AS and controls, but more controls received statin therapy (P = 0.05). GLS was significantly lower in patients with AS compared to controls (mean ± SD -17.7 ± 2.5% versus -18.4 ± 2.3%; P = 0.03). In univariable linear regression analyses in the total study population, lower GLS was associated with having AS, male sex, higher body mass index, higher LV mass index, and lower LV ejection fraction (all P < 0.05). Having AS retained an independent association with lower GLS when adjusted for these factors in multivariable analyses (β = 0.16, P = 0.02). In patients with AS, lower GLS was independently associated with larger aortic root diameter in multivariable analyses (β = 0.24, P = 0.02), while no association with AS disease activity, disease duration, or use of antirheumatic medication was observed. CONCLUSION Patients with AS had lower GLS compared with controls, independent of confounders. In AS patients, lower GLS was associated with larger aortic root diameter. Prospective studies should test whether lower GLS contributes to the observed higher CVD risk in patients with AS.
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25
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Danve A. Thoracic Manifestations of Ankylosing Spondylitis, Inflammatory Bowel Disease, and Relapsing Polychondritis. Clin Chest Med 2019; 40:599-608. [PMID: 31376894 DOI: 10.1016/j.ccm.2019.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Ankylosing spondylitis, inflammatory bowel disease (IBD), and relapsing polychondritis are immune-mediated inflammatory diseases with variable involvement of lungs, heart and the chest wall. Ankylosing spondylitis is associated with anterior chest wall pain, restrictive lung disease, obstructive sleep apnea, apical fibrosis, spontaneous pneumothorax, abnormalities of cardiac valves and conduction system, and aortitis. Patients with IBD can develop necrobiotic lung nodules that can be misdiagnosed as malignancy or infection. Relapsing polychondritis involves large airways in at least half of the patients. Relapsing polychondritis can mimic asthma in some patients. Medications used to treat these inflammatory conditions can cause pulmonary complications such as infections, pneumonitis, and rarely serositis.
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Affiliation(s)
- Abhijeet Danve
- Section of Rheumatology, Department of Medicine, Yale School of Medicine, 300 Cedar Street, TACS-525, New Haven, CT 06520-8031, USA.
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Cardiac Manifestations of Seronegative Spondyloarthropathy in a Human Leukocyte Antigen B27-Positive African American Woman: A Case Report With Literature Review. ACTA ACUST UNITED AC 2019; 3:239-243. [PMID: 31709378 PMCID: PMC6833126 DOI: 10.1016/j.case.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Valvular heart disease is a complication of seronegative spondyloarthropathy. Aortic regurgitation is the most common valvular disease encountered. Other cardiac sequelae include mitral regurgitation and conduction disease.
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Buleu F, Sirbu E, Caraba A, Dragan S. Heart Involvement in Inflammatory Rheumatic Diseases: A Systematic Literature Review. ACTA ACUST UNITED AC 2019; 55:medicina55060249. [PMID: 31174287 PMCID: PMC6632037 DOI: 10.3390/medicina55060249] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/29/2019] [Accepted: 05/31/2019] [Indexed: 12/31/2022]
Abstract
Introduction: Patients with inflammatory rheumatic diseases have an increased risk of developing cardiovascular manifestations. The high risk of cardiovascular pathology in these patients is not only due to traditional cardiovascular risk factors (age, gender, family history, smoking, sedentary lifestyle, cholesterol), but also to chronic inflammation and autoimmunity. Aim: In this review, we present the mechanisms of cardiovascular comorbidities associated with inflammatory rheumatic diseases, as they have recently been reported by different authors, grouped in electrical abnormalities, valvular, myocardial and pericardial modifications and vascular involvement. Methods: We conducted a systematic search of published literature on the following online databases: EBSCO, ScienceDirect, Scopus and PubMed. Searches were limited to full-text English-language journal articles published between 2010 and 2017 using the following key words: heart, systemic inflammation, autoimmunity, rheumatic diseases and disease activity. After the primary analysis we included 50 scientific articles in this review. Results: The results showed that cardiac manifestations of systemic inflammation can occur frequently with different prevalence in rheumatoid arthritis (RA), systemic lupus erythematosus(SLE), systemic sclerosis(SSc) and ankylosing spondylitis(AS). Rheumatologic diseases can affect the myocardium, cardiac valves, pericardium, conduction system and arterial vasculature. Conclusions: Early detection, adequate management and therapy of specific cardiac involvement are essential in rheumatic disease. Electrocardiographic and echocardiographic evaluation should be performed as routine investigations in patients with inflammatory rheumatic diseases.
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Affiliation(s)
- Florina Buleu
- Departament of Cardiology, Faculty of Medicine, University of Medicine and Pharmacy "Victor Babeș", Timișoara 300041, Romania.
| | - Elena Sirbu
- Department of Physical Therapy and Special Motricity, West University of Timișoara, Timișoara 300223, Romania.
| | - Alexandru Caraba
- Departament of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy "Victor Babeș", Timișoara 300041, Romania.
| | - Simona Dragan
- Departament of Cardiology, Faculty of Medicine, University of Medicine and Pharmacy "Victor Babeș", Timișoara 300041, Romania.
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Roldan PC, Greene ER, Qualls CR, Sibbitt WL, Roldan CA. Progression of atherosclerosis versus arterial stiffness with age within and between arteries in systemic lupus erythematosus. Rheumatol Int 2019; 39:1027-1036. [PMID: 30877372 DOI: 10.1007/s00296-019-04267-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 02/26/2019] [Indexed: 12/31/2022]
Abstract
The progression of atherosclerosis versus arterial stiffness with age within and between arteries has not been defined. Systemic lupus erythematosus (SLE) is a human model of accelerated arterial disease that may permit this determination. 76 SLE patients (69 women, age 37 ± 12 years) and 26 age-and-sex-matched controls (22 women, age 34 ± 11 years) underwent transesophageal echocardiography and carotid ultrasonography for assessment of atherosclerosis [plaques and intima-media thickening (IMT)] and arterial stiffness [increased pressure-strain elastic modulus (PSEM)] of the descending thoracic aorta and carotid arteries. Since IMT is highly associated with plaques, IMT was used as a marker of atherosclerosis to assess its progression in relation with age and PSEM. Aortic and carotid plaques, IMT, and PSEM were greater in patients than in controls (all p ≤ 0.05). Within the aorta and within the carotid arteries, the average percent increases per decade of age for IMT versus PSEM were similar in patients (8.55% versus 9.33% and 3.39% versus 2.46%, respectively) and controls (5.53% versus 6.60% and 4.75% versus 3.49%, respectively) (all p ≥ 0.58). However, in SLE patients, the average percent increases per decade of age for IMT and PSEM were higher in the aorta than in the carotid arteries (8.55% and 9.33% versus 3.39% and 2.46%, respectively, both p ≤ 0.03). In patients with SLE, atherosclerosis and arterial stiffness progress with age parallel to each other within arteries, but divergently between arteries with different anatomy and hemodynamics.
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Affiliation(s)
- Paola C Roldan
- Divisions of Cardiology and Rheumatology, Department of Medicine, University of New Mexico School of Medicine, Cardiology 5-ACC, MSC 10-5550, University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Ernest R Greene
- Divisions of Cardiology and Rheumatology, Department of Medicine, University of New Mexico School of Medicine, Cardiology 5-ACC, MSC 10-5550, University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Clifford R Qualls
- Divisions of Cardiology and Rheumatology, Department of Medicine, University of New Mexico School of Medicine, Cardiology 5-ACC, MSC 10-5550, University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Wilmer L Sibbitt
- Divisions of Cardiology and Rheumatology, Department of Medicine, University of New Mexico School of Medicine, Cardiology 5-ACC, MSC 10-5550, University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Carlos A Roldan
- Divisions of Cardiology and Rheumatology, Department of Medicine, University of New Mexico School of Medicine, Cardiology 5-ACC, MSC 10-5550, University of New Mexico, Albuquerque, NM, 87131-0001, USA.
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Ozkaramanli Gur D, Ozaltun DN, Guzel S, Sarifakioglu B, Akyuz A, Alpsoy S, Aycicek O, Baykiz D. Novel imaging modalities in detection of cardiovascular involvement in ankylosing spondylitis. SCAND CARDIOVASC J 2019; 52:320-327. [DOI: 10.1080/14017431.2018.1551564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Savas Guzel
- Biochemistry Department, Namik Kemal University, Tekirdag, Turkey
| | - Banu Sarifakioglu
- Physical Therapy and Rehabilitation Department, Namik Kemal University, Tekirdag, Turkey
| | - Aydin Akyuz
- Cardiology Department, Namik Kemal University, Tekirdag, Turkey
| | - Seref Alpsoy
- Cardiology Department, Namik Kemal University, Tekirdag, Turkey
| | - Ozge Aycicek
- Biochemistry Department, Namik Kemal University, Tekirdag, Turkey
| | - Derya Baykiz
- Cardiology Department, Tekirdag State Hospital, Tekirdag, Turkey
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Moltó A, Dougados M. Comorbidities in spondyloarthritis including psoriatic arthritis. Best Pract Res Clin Rheumatol 2018; 32:390-400. [PMID: 31171310 DOI: 10.1016/j.berh.2018.09.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/25/2018] [Accepted: 07/28/2018] [Indexed: 12/20/2022]
Abstract
Comorbidities in spondyloarthritis (SpA) including psoriatic arthritis have to be differentiated to the concept of clinical features of SpA (e.g., uveitis, psoriasis, and inflammatory bowel disease). In addition to atherosclerosis-related cardiovascular diseases, the most frequent comorbidities in SpA are osteoporosis, fibromyalgia, and depression. Moreover, the current available drug therapies (e.g., NSAIDs, corticosteroids, and biologics) might increase the risk of some comorbidities such as infections and gastrointestinal disorders. Awareness about these comorbidities is crucial to improve their screening and management. For this purpose, any systematic periodical review should integrate a program (ideally internationally standardized) focused on comorbidities.
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Affiliation(s)
- Anna Moltó
- Paris Descartes University, Department of Rheumatology, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, France; INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris, Cité. Paris, France.
| | - Maxime Dougados
- Paris Descartes University, Department of Rheumatology, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, France; INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris, Cité. Paris, France
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Braun J, Krüger K, Manger B, Schneider M, Specker C, Trappe HJ. Cardiovascular Comorbidity in Inflammatory Rheumatological Conditions. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:197-203. [PMID: 28407841 DOI: 10.3238/arztebl.2017.0197] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 05/03/2016] [Accepted: 01/18/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Approximately 1.5 million adults in Germany suffer from an inflammatory rheumatological condition. The most common among these are rheumatoid arthritis and spondyloarthritis-above all axial spondyloarthritis, including ankylosing spondylitis (Bekhterev's disease) and psoriatic arthritis. These systemic inflammatory diseases often affect the heart as well. METHODS This review is based on pertinent articles retrieved by a selective literature search, on current European guidelines, and on the authors' clinical experience. RESULTS Rheumatic inflammation of cardiac structures can manifest itself as pericarditis, myocarditis, or endocarditis. The heart valves and the intracardiac conduction system can be affected as well, leading to AV block. Functional sequelae, e.g., congestive heart failure, can arise as a consequence of any inflammatory rheumatic disease. The long-term mortality of rheumatic diseases is elevated predominantly because of the increased risk for cardiovascular comorbidities. The cardiovascular risk profile should therefore be re-evaluated regularly (e.g., at 5-year intervals) in cooperation with the patient's primary care physician. The cardiovascular manifestations of rheumatic disease, such as pericarditis, myocarditis, and vasculitis, are treated initially with high-dose glucocorticoids and then over the long term with maintenance drugs such as methotrexate and azathioprine. Biological agents are sometimes used as well. CONCLUSION In patients with inflammatory rheumatic diseases, the elevated cardiovascular risk should be kept in mind and preventive measures should be initiated early. This subject should be further studied in controlled trials so that the treatment options for patients with cardiac involvement can be evaluated.
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Affiliation(s)
- Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne; Rheumazentrum München, Munich; Department of Medicine 3, Universitätsklinikum Erlangen; Department of Rheumatology, Hiller Research Center Rheumatology, University Hospital Düsseldorf; Department of Rheumatology and Clinical Immunology, St. Josef Krankenhaus, Essen University Hospital; Department of Cardiology, Marien-Hospital Herne, University Hospitals of the Ruhr University of Bochum
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Moon I, Choi EK, Jung JH, Han KD, Choi YJ, Park J, Cho JH, Lee E, Choe W, Lee SR, Cha MJ, Lim WH, Oh S. Ankylosing spondylitis: A novel risk factor for atrial fibrillation - A nationwide population-based study. Int J Cardiol 2018; 275:77-82. [PMID: 30360993 DOI: 10.1016/j.ijcard.2018.10.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/24/2018] [Accepted: 10/05/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease, associated with a number of cardiovascular diseases. We sought to investigate whether AS increases the risk of atrial fibrillation (AF) in a nationwide population-based study. METHODS A total of 14,129 patients newly diagnosed with AS (mean age 41.8 ± 15.3 years, 72% male) were recruited from the Korean National Health Insurance Service database between 2010 and 2014 and followed up for new onset AF. Age- and sex-matched non-AS subjects (1:5, n = 70,645) were selected and compared with the AS patients. RESULTS During a mean follow-up of 3.5 years, AF was newly diagnosed in 486 patients (114 patients of the AS group). The AS patients developed AF more frequently than the non-AS subjects (2.32 vs. 1.51 per 1000 person-years). In multivariate Cox regression analysis, AS was an independent risk factor for AF (Hazard ratio [HR] 1.28, 95% confidence interval [1.03-1.58]). The AS with tumor necrosis factor inhibitor (TNFi) therapy group showed higher risk for AF (HR 1.60 [1.02-2.39]). In younger patients of the AS group (patients <40 years old), the risk for AF was three times higher than patients at same age in the non-AS group. AS was an independent risk factor for AF in men, but not in women (HR 1.53 [1.18-1.95]; HR 1.42 [0.94-2.08], respectively). CONCLUSIONS AS was an independent risk factor for AF, especially in those under 40 years of age and those administered TNFi. It would be reasonable to screen for AF and stroke prevention in these high-risk patients.
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Affiliation(s)
- Inki Moon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Jin-Hyung Jung
- Department of Biostatistics, College of Medicine, The Catholic University of, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of, Seoul, Republic of Korea
| | - You-Jung Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jiesuck Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jun Hwan Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Euijae Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wonseok Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Soon Chun Hyang University Hospital Seoul, Seoul, Republic of Korea
| | - Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo-Hyun Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Kocabaş H, Öncel CR, küçük M, Belgi Yıldırım A, kaçar C. Ankilozan Spondilit Hastalarında Kırmızı Hücre Dağılım Genişliği Ve Subklinik Sol Ventrikül Disfonksiyonu. ACTA MEDICA ALANYA 2018. [DOI: 10.30565/medalanya.393936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Midtbø H, Gerdts E, Berg IJ, Rollefstad S, Jonsson R, Semb AG. Ankylosing Spondylitis Is Associated with Increased Prevalence of Left Ventricular Hypertrophy. J Rheumatol 2018; 45:1249-1255. [PMID: 29858235 DOI: 10.3899/jrheum.171124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Ankylosing spondylitis (AS) is associated with increased risk for cardiovascular disease (CVD). Left ventricular (LV) hypertrophy is a strong precursor for clinical CVD. The aim of our study was to assess whether having AS was associated with increased prevalence of LV hypertrophy. METHODS Clinical and echocardiographic data from 139 AS patients and 126 age- and sex-matched controls was used. LV mass was calculated according to guidelines and indexed to height2.7. LV hypertrophy was considered present if LV mass index was > 49.2 g/m2.7 in men and > 46.7 g/m2.7 in women. RESULTS Patients with AS were on average 49 ± 12 years old, and 60% were men. The prevalence of hypertension (HTN; 35% vs 41%) and diabetes (5% vs 2%) was similar among patients and controls, while patients with AS had higher serum C-reactive protein level (CRP; p < 0.001). The prevalence of LV hypertrophy was higher in patients with AS compared to controls (15% vs 6%, p = 0.01). In multivariable logistic regression analysis, having AS was associated with OR 6.3 (95% CI 2.1-19.3, p = 0.001) of having LV hypertrophy independent of the presence of HTN, diabetes, and obesity. In multivariable linear regression analyses, having AS was also associated with higher LV mass (β 0.15, p = 0.007) after adjusting for CVD risk factors including sex, body mass index, systolic blood pressure, diabetes, and serum CRP (multiple R2 = 0.41, p < 0.001). CONCLUSION Having AS was associated with increased prevalence of LV hypertrophy independent of CVD risk factors. This finding strengthens the indication for thorough CVD risk assessment in patients with AS.
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Affiliation(s)
- Helga Midtbø
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. .,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital.
| | - Eva Gerdts
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital
| | - Inger Jorid Berg
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital
| | - Silvia Rollefstad
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital
| | - Roland Jonsson
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital
| | - Anne Grete Semb
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital
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Bengtsson K, Forsblad-d’Elia H, Lie E, Klingberg E, Dehlin M, Exarchou S, Lindström U, Askling J, Jacobsson LTH. Risk of cardiac rhythm disturbances and aortic regurgitation in different spondyloarthritis subtypes in comparison with general population: a register-based study from Sweden. Ann Rheum Dis 2017; 77:541-548. [DOI: 10.1136/annrheumdis-2017-212189] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/30/2017] [Accepted: 11/21/2017] [Indexed: 12/17/2022]
Abstract
ObjectivesTo describe the incidence of atrioventricular (AV) block II–III, atrial fibrillation (AF), pacemaker implantation (PM) and aortic regurgitation in patients with ankylosing spondylitis (AS), undifferentiated spondyloarthritis (uSpA) and psoriatic arthritis (PsA) compared with the general population (GP) and with each other.MethodsA prospective nationwide study with cohorts of patients with AS (n=6448), PsA (n=16 063) and uSpA (n=5190) and a GP (n=2 66 435) cohort, identified in 2001–2009 in the Swedish National Patient and Population registers. Follow-up began on 1 January 2006 and ended at event, death, emigration or 31 December 2012. Age-standardised and sex-standardised incidence rates and hazard ratios (HRs) were calculated.ResultsThe highest incidence rates were noted for AF (5.5–7.4 events per 1000 person-years), followed by PM (1.0–2.0 events per 1000 person-years). HRs for AV block, AF, PM and aortic regurgitation were significantly increased in AS (HRs 2.3, 1.3, 2.1 and 1.9), uSpA (HRs 2.9, 1.3, 1.9 and 2.0) and PsA (HRs 1.5, 1.5, 1.6 and 1.8) compared with the GP cohort. The highest HRs were seen for AV block in male uSpA (HR 4.2) and AS (HR 2.5) compared with GP. Compared with PsA, significantly increased HRs were noted for PM (HR 1.5) in AS and for AV block (HR 1.8) in uSpA.ConclusionsPatients with SpA are at increased risk of aortic regurgitation, cardiac rhythm disturbances and, as a probable consequence, also PM. Particularly for AF, the most common arrhythmia, increased caution is warranted, whereas AV block should be looked for especially in men with AS or uSpA.
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Ljung L, Sundström B, Smeds J, Ketonen M, Forsblad-d'Elia H. Patterns of comorbidity and disease characteristics among patients with ankylosing spondylitis-a cross-sectional study. Clin Rheumatol 2017; 37:647-653. [PMID: 29119482 PMCID: PMC5835056 DOI: 10.1007/s10067-017-3894-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/21/2017] [Accepted: 10/24/2017] [Indexed: 01/06/2023]
Abstract
The knowledge of the development of comorbidities in patients with ankylosing spondylitis (AS) is limited. The aim of this study was to analyse associations between AS disease characteristics and comorbidity and to evaluate patterns of comorbidities in patients with AS. Patients with AS, fulfilling the modified New York Criteria, were identified (n = 346, mean age 56 ± 15 years, 75% men, 99% HLA B27 positive). Through a review of the patient records, data on disease activity parameters, laboratory results, disease manifestations, and diagnoses of any clinically significant comorbidity was obtained. Four categories of comorbidities of interest were identified: A. arrhythmias, conduction disorders, and valvular heart disease; B. atherosclerosis and atherosclerotic CVD; C. spinal and non-spinal fractures; and D. obstructive sleep apnoea syndrome. Associations between AS disease characteristics and comorbidities in categories were assessed in logistic regression models. Differences in proportions of comorbidities was analysed using two-sided chi-square. Age was associated with all four categories of comorbidities, and male sex with arrhythmias, conduction disorders, valvular heart disease, and obstructive sleep apnoea syndrome. Early disease onset and long disease duration, respectively, were associated with arrhythmias, conduction disorders, and valvular heart disease. Obstructive sleep apnoea syndrome was associated with features of the metabolic syndrome. Patients with atherosclerotic cardiovascular disease had an increased risk of most other comorbidities, similar to, but more pronounced than patients with arrhythmias, conduction disorders and valvular heart disease. Comorbid conditions motivate clinical awareness among patients with AS. Longitudinal studies are needed to establish preventive measures.
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Affiliation(s)
- Lotta Ljung
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, S-901 87, Umeå, Sweden.
| | - Björn Sundström
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, S-901 87, Umeå, Sweden
| | - Johan Smeds
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, S-901 87, Umeå, Sweden
| | - Maria Ketonen
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, S-901 87, Umeå, Sweden
| | - Helena Forsblad-d'Elia
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, S-901 87, Umeå, Sweden
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Abstract
Cardiovascular disease is an important extra-articular manifestation of rheumatologic diseases leading to considerable mortality and morbidity. Echocardiography emerges as a useful non-invasive technique for the screening and evaluation of cardiac involvement in these patients. With the technological advancement in echocardiographic techniques, we have gained a greater appreciation of the prevalence and nature of the cardiac involvement in these patients, as detection of subclinical disease is increasingly feasible. This review discusses cardiac involvement in patients with rheumatoid arthritis, systemic lupus erythematosus, anti-phospholipid antibody syndrome, systemic sclerosis and ankylosing spondylitis, and the role of different echocardiographic modalities in their evaluation.
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Affiliation(s)
- Maha A Al-Mohaissen
- Department of Clinical Sciences (Cardiology), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Kwan-Leung Chan
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, ON, Canada. .,University of Ottawa Heart Institute, 40 Ruskin Street, Room H3412, Ottawa, ON, K1Y 4W7, Canada.
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Mielnik P, Hjelle AM, Nordeide JL. Coexistence of Takayasu’s arteritis and ankylosing spondylitis may not be accidental – Is there a need for a new subgroup in the spondyloarthritis family? Mod Rheumatol 2017; 28:313-318. [DOI: 10.1080/14397595.2017.1341592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Pawel Mielnik
- Section for Rheumatology, Department for Neurology, Rheumatology and Physical Medicine, Helse Førde, Førde, Norway
| | - Anja Myhre Hjelle
- Section for Rheumatology, Department for Neurology, Rheumatology and Physical Medicine, Helse Førde, Førde, Norway
| | - Jan Leidulv Nordeide
- Section for Rheumatology, Department for Neurology, Rheumatology and Physical Medicine, Helse Førde, Førde, Norway
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Biesbroek PS, Heslinga SC, Konings TC, van der Horst-Bruinsma IE, Hofman MBM, van de Ven PM, Kamp O, van Halm VP, Peters MJL, Smulders YM, van Rossum AC, Nurmohamed MT, Nijveldt R. Insights into cardiac involvement in ankylosing spondylitis from cardiovascular magnetic resonance. Heart 2016; 103:745-752. [PMID: 27852696 DOI: 10.1136/heartjnl-2016-310667] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/26/2016] [Accepted: 10/28/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate cardiac involvement in patients with ankylosing spondylitis using cardiac magnetic resonance (CMR). METHODS Patients with ankylosing spondylitis without cardiovascular symptoms or known cardiovascular disease were screened by transthoracic echocardiography (TTE) for participation in this exploratory CMR study. We prospectively enrolled 15 ankylosing spondylitis patients with an abnormal TTE for further tissue characterisation using late gadolinium enhancement (LGE) and T1 mapping. T1 mapping was used to calculate myocardial extracellular volume (ECV). Disease activity was assessed by C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) measurements. RESULTS In the total of 15 included patients, 14 had a complete CMR exam (mean age 62 years, 93% male and mean disease duration 21 years). Left ventricular (LV) diastolic dysfunction was the most common finding on TTE (79%), followed by aortic root dilatation (14%), right ventricular (RV) dilatation (7%) and RV dysfunction (7%). CMR revealed focal hyperenhancement in three patients (21%), all with a particular pattern of enhancement. LV dysfunction, as defined by a LV ejection fraction below 55%, was observed in five patients (36%). Myocardial ECV was correlated with the CRP concentration (R=0.78, p<0.01) and ESR level (RS=0.73, p<0.01). CONCLUSIONS In patients with ankylosing spondylitis, CMR with cine imaging and LGE identified global LV dysfunction and focal areas of hyperenhancement. Myocardial ECV, quantified by CMR T1 mapping, was associated with the degree of disease activity. These results may suggest the presence of cardiac involvement in ankylosing spondylitis and may show the potential of ECV as a marker for disease monitoring.
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Affiliation(s)
- P Stefan Biesbroek
- Departments of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Sjoerd C Heslinga
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Thelma C Konings
- Departments of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Irene E van der Horst-Bruinsma
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Mark B M Hofman
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Otto Kamp
- Departments of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Vokko P van Halm
- Departments of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Mike J L Peters
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Yvo M Smulders
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Departments of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Mike T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade Amsterdam, The Netherlands
| | - Robin Nijveldt
- Departments of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
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Reinhardt A, Yevsa T, Worbs T, Lienenklaus S, Sandrock I, Oberdörfer L, Korn T, Weiss S, Förster R, Prinz I. Interleukin-23-Dependent γ/δ T Cells Produce Interleukin-17 and Accumulate in the Enthesis, Aortic Valve, and Ciliary Body in Mice. Arthritis Rheumatol 2016; 68:2476-86. [PMID: 27111864 DOI: 10.1002/art.39732] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 04/21/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The spondyloarthritides (SpA) are a group of rheumatic diseases characterized by ossification and inflammation of entheseal tissue, the region where tendon attaches to bone. Interleukin-23 (IL-23) is involved in the pathogenesis of SpA by acting on IL-23 receptor (IL-23R) expressed on enthesis-resident lymphocytes. Upon IL-23 binding, CD3+CD4-CD8- tissue-resident lymphocytes secrete IL-17A and IL-22, leading to inflammation, bone loss, and ossification. Knowledge about enthesis-resident lymphocytes remains fragmentary, and the contribution of entheseal γ/δ T cells in particular is not clear. This study was undertaken to investigate the presence of γ/δ T cells in the enthesis. METHODS We used 2-photon microscopy and flow cytometry to analyze entheseal lymphocytes from C57BL/6, Tcrd-H2BeGFP, Rorc-GFP, and IL-23R-eGFP mice. To analyze entheseal γ/δ T cells in IL-23-induced inflammation, Tcrd-H2BeGFP mice were crossed with mice of the susceptible B10.RIII background. Hydrodynamic injection of IL-23 minicircle DNA was performed for overexpression of IL-23 and induction of inflammation. Light-sheet fluorescence microscopy was used to visualize arthritic inflammation. RESULTS Activated Vγ6+CD27- γ/δ T cells were abundant in uninflamed entheseal tissue and constituted the large majority of retinoic acid receptor-related orphan nuclear receptor γt (RORγt)+IL-23R+ enthesis-resident lymphocytes. Fetal thymus-dependent γ/δ T cells were the main source of IL-17A at the enthesis. Under inflammatory conditions, γ/δ T cells increased in number at the Achilles tendon enthesis, aortic root, and adjacent to the ciliary body. CONCLUSION Entheseal γ/δ T cells are derived from fetal thymus and are maintained as self-renewing tissue-resident cells. As main IL-17A producers within tissues exposed to mechanical stress including enthesis, γ/δ T cells are key players in the pathogenesis of IL-23-induced local inflammation.
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Affiliation(s)
| | | | - Tim Worbs
- Hannover Medical School, Hannover, Germany
| | | | | | | | - Thomas Korn
- Klinikum rechts der Isar, Technische Universität München and Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | | | | | - Immo Prinz
- Hannover Medical School, Hannover, Germany.
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Differences in cardiovascular manifestations between ankylosing spondylitis patients with and without kyphosis. Clin Rheumatol 2016; 35:2003-2008. [PMID: 27271532 DOI: 10.1007/s10067-016-3324-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/22/2016] [Accepted: 05/28/2016] [Indexed: 01/08/2023]
Abstract
The objective of this study is to evaluate the differences in cardiovascular manifestations between ankylosing spondylitis (AS) patients with and without kyphosis. A retrospective review of consecutive AS patients treated at our hospital between June 2013 and June 2015 was performed. There were 122 patients who met all of the inclusion and exclusion criteria. Among these patients, there were 57 (ASK group) patients with global kyphosis (GK) > 40° and 65 (AS group) patients with GK < 40°. General information, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), electrocardiography, and echocardiography were record. ESR and CRP levels in the ASK group were significantly higher than the AS group (P < 0.05). Fifteen patients in ASK group but 3 patients in AS group suffered from a left ventricular high voltage (P < 0.05). Heart rate in ASK group was 83.91 ± 13.68 beats/min, and it was 73.88 ± 13.04 beats/min in AS group (P < 0.05). The E/A ratio was 1.13 ± 0.38 in ASK group and 1.32 ± 0.49 in AS group (P < 0.05). The mitral E-wave deceleration time and isovolumetric relaxation time were, respectively, 236.25 ± 34.26 ms and 101.86 ± 17.57 ms in ASK group, which were shorter in AS group (P < 0.05). This study showed that AS patients with kyphosis had a statistically increased incidence of cardiovascular complications including a more rapid heart rate, left ventricular high voltage, and left ventricular diastolic dysfunction.
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Abstract
Ankylosing spondylitis is one of the subgroup of diseases called “seronegative spondyloarthropathy”. Frequently, it affects the vertebral colon and sacroiliac joint primarily and affects the peripheral joints less often. This chronic, inflammatory and rheumatic disease can also affect the extraarticular regions of the body. The extraarticular affections can be ophthalmologic, cardiac, pulmonary or neurologic. The cardiac affection can be 2-10% in all patients. Cardiac complications such as left ventricular dysfunction, aortitis, aortic regurgitation, pericarditis and cardiomegaly are reviewed.
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Affiliation(s)
- Yasemin Ozkan
- Physical Medicine and Rehabilitation, Department of Medicine, University of Dumlupinar, 4300 Kutahya, Turkey.
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Amin A, Chitsazan M, Navid H. Left ventricular systolic dysfunction in two patients with ankylosing spondylitis: What is the role of corticosteroids? Eur J Rheumatol 2016; 3:179-181. [PMID: 28149663 DOI: 10.5152/eurjrheum.2016.15069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/14/2015] [Indexed: 11/22/2022] Open
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory condition that most commonly affects the axial skeleton. The most common cardiac manifestation in patients with AS is the aortic root and valve disease, followed by conduction and rhythm abnormalities, decreased coronary flow reserve, myocardial infarction, and diastolic dysfunction. However, the presence of systolic dysfunction has been less described in patients with AS. Herein we present two cases of idiopathic dilated cardiomyopathy in patients with AS. These patients were noted to have an improvement of their ejection fraction following treatment of AS. Clinical and echocardiographic improvement on anti-inflammatory treatment might be a clue to the inflammatory nature of this myocardial problem, and further investigations to study the issue is required.
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Affiliation(s)
- Ahmad Amin
- Department of Heart Failure and Transplantation, Rajaei Cardiovascular, Medical and Research Center, Iran, University of Medical Sciences, Tehran, Iran
| | - Mitra Chitsazan
- Department of Heart Failure and Transplantation, Rajaei Cardiovascular, Medical and Research Center, Iran, University of Medical Sciences, Tehran, Iran
| | - Hossein Navid
- Department of Heart Failure and Transplantation, Rajaei Cardiovascular, Medical and Research Center, Iran, University of Medical Sciences, Tehran, Iran
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Soroush M, Mominzadeh M, Ghelich Y, Soroosh S, Pasha MA. Investigation of Cardiac Complications and their Incidence in Patients with Ankylosing Spondylitis. Med Arch 2016; 70:35-8. [PMID: 26980929 PMCID: PMC4779348 DOI: 10.5455/medarh.2016.70.35-38] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/30/2015] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Ankylosing Spondylitis (AS) is a chronic inflammatory disease with unknown etiology which involves the sacroiliac and axial joints, but can also cause peripheral conflicts. It also comprises non-joint symptoms such as acute anterior uveitis, cardiac conduction defects, upper lobe pulmonary fibrosis, neurological involvement and renal amyloidosis. MATERIAL AND METHODS This study was a cross-sectional descriptive and analytical survey. In this study, 50 patients with AS were examined according to the New York Criteria in Army 501 Hospital in Tehran. Physical examinations, laboratory testing and HLA-B27, as well as X-ray of the spine and sacroiliac joint were taken from all subjects and involvement grading was identified. The control group consisted of 40 healthy people with no evidence of disease. The people resembled the study group in terms of age, sex, smoking, presence of high blood pressure, history of ischemic heart disease and also diabetes. RESULTS The mean age of patients in control and study group was 33.97 and 33.65 years, respectively. 37 (92.5%) patients in the control group and 46 in study group (92%) were male. The mean duration of cardiac involvement in patients was 8.6 years with SD=6.26. In AS group, 48 (96%) patients suffered from back pain, 43 from enteritis, 100% from Ankylosing Spondylitis, one from unilateral involvement, 22(44%) from peripheral arthritis and 27 (54%) from HLA-B27. CONCLUSION In total, Average heart involvement in the control group and AS group was 13.25 with SD=7.64 and 16.2 with SA=8.54, respectively, indicating no significant difference. In sum, based on the results obtained in this study, some types of heart involvements, such as mitral valve regurgitation and Mitral Valve Prolapse in AS patients are more prevalent than in the normal population.
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Affiliation(s)
- Mohsen Soroush
- Department of Rheumatology, AJA University of Medical Sciences, Tehran, Iran
| | - Mahmood Mominzadeh
- Department of Rheumatology, AJA University of Medical Sciences, Tehran, Iran
| | - Younes Ghelich
- Department of Cardiology, 502 Hospital, AJA university of Medical Sciences, Tehran, Iran
| | - Soosan Soroosh
- Department of Rheumatology, AJA University of Medical Sciences, Tehran, Iran
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Bossone E, Pluchinotta FR, Andreas M, Blanc P, Citro R, Limongelli G, Della Corte A, Parikh A, Frigiola A, Lerakis S, Ehrlich M, Aboyans V. Aortitis. Vascul Pharmacol 2015; 80:1-10. [PMID: 26721213 DOI: 10.1016/j.vph.2015.11.084] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 01/13/2023]
Abstract
Aortitis encompasses all conditions, infectious or non-infectious, leading to different types of inflammation of the aortic wall. The clinical manifestations are usually nonspecific, as are laboratory findings, and sometimes may mimic other diseases. Imaging modalities can help in the assessment of these patients and are often required for making the final diagnosis. It is extremely important to establish an early diagnosis in order to treat timely potentially life-threatening conditions. Anti-inflammatory drugs, antibiotics, sometimes in combination with surgical or endovascular therapies, are proposed according to etiology and disease severity. This review focuses on the classification, epidemiology, diagnostic approach, and management of aortitis with which physicians should be familiar.
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Affiliation(s)
| | - Francesca R Pluchinotta
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS Policlinico San Donato, Milan, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Philippe Blanc
- Department of Nuclear Medicine, Dupuytren University Hospital, Limoges, France
| | - Rodolfo Citro
- Heart Department, University Hospital, Salerno, Italy
| | - Giuseppe Limongelli
- Division of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Alessandro Della Corte
- Department of Cardiothoracic Sciences, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Ankit Parikh
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Alessandro Frigiola
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS Policlinico San Donato, Milan, Italy
| | - Stamatios Lerakis
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Marek Ehrlich
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Limoges, France; Inserm 1094, Limoges School of Medicine, Limoges, France
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Klingberg E, Sveälv BG, Täng MS, Bech-Hanssen O, Forsblad-d'Elia H, Bergfeldt L. Aortic Regurgitation Is Common in Ankylosing Spondylitis: Time for Routine Echocardiography Evaluation? Am J Med 2015; 128:1244-1250.e1. [PMID: 26052024 DOI: 10.1016/j.amjmed.2015.04.032] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 04/21/2015] [Accepted: 04/21/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study was to assess the prevalence of aortic regurgitation and any relation to disease activity and specific human leukocyte antigen (HLA)-B27 subtypes in patients with ankylosing spondylitis. METHODS Transthoracic echocardiography was performed in 187 patients (105 men), mean age (SD) 50 (13) years, and mean disease duration 24 (13) years, and was related to demographic, clinical, radiographic, electrocardiographic, and laboratory data. RESULTS Aortic regurgitation was found in 34 patients (18%; 95% confidence interval [CI], 12%-24%): mild in 24, moderate in 9, and severe in one. The prevalence was significantly higher than expected from population data. Conduction system abnormalities were documented in 25 patients (13%; 95% CI, 8%-18%), and significantly more likely in the presence of aortic regurgitation (P = .005), which was related to increasing age and longstanding disease, and increased from ~20% in the 50s to 55% in the 70s. It was also independently associated with disease duration, with higher modified Stoke Ankylosing Spondylitis Spine Score, and with a history of anterior uveitis. HLA-B27 was present in similar proportions in the presence vs absence of aortic regurgitation. For comparison, clinically significant coronary artery disease was present in 9 patients (5%; 95% CI, 2%-8%). CONCLUSION Patients with ankylosing spondylitis frequently have cardiac abnormalities, but they more often consist of disease-related aortic regurgitation or conduction system abnormalities than manifestations of atherosclerotic heart disease. Because aortic regurgitation or conduction abnormalities might cause insidious symptoms not easily interpreted as of cardiac origin, we suggest that both electrocardiography and echocardiography evaluation should be part of the routine management of patients with ankylosing spondylitis.
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Affiliation(s)
- Eva Klingberg
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Bente Grüner Sveälv
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Margareta Scharin Täng
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Odd Bech-Hanssen
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Helena Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Lennart Bergfeldt
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
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Śliwczyński A, Raciborski F, Kłak A, Brzozowska M, Czeleko T, Kwiatkowska B, Jędrzejczyk T, Marczak M. Prevalence of ankylosing spondylitis in Poland and costs generated by AS patients in the public healthcare system. Rheumatol Int 2015; 35:1361-7. [PMID: 25773659 DOI: 10.1007/s00296-015-3247-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 03/05/2015] [Indexed: 12/17/2022]
Abstract
The aim of the research was to analyse the prevalence of ankylosing spondylitis (AS) in Poland and to assess the costs generated by AS patients in the system of public health care. The database of national payer-National Health Fund (NHF)-has been analysed. For the analysis, the information has been extracted from IT system about each treated patient with ICD-10 = M45 code as main or coexisting diagnosis included in the mandatory reports from entities of public healthcare service. In the years 2008-2013, from 28,800 to 32,800 persons diagnosed with AS as main or coexisting diagnosis have been registered in NHF database. In 2013, the prevalence amounted to 7.48 for 10,000 persons of general population-the highest in Kujawy-Pomerania province (10.92 per 10,000 inhabitants), Silesia (10.04) and Świętokrzyskie province (9.81). In male patients, this coefficient amounted to 8.91 per 10,000 inhabitants, whereas in female-to 6.15. In 2013, the prevalence for men was the highest in the age group of 60-64 years and for women in the group of 65-69 years. The healthcare expenses related to AS financed by the NHF increased from 13,200 million PLN (6.3 million USD) in 2008 to 72,600 million PLN (21,900 million USD) in 2013. The increase in healthcare expenses related to AS patients in the public healthcare system is significant and noticeable. High regional diversity is also a vital issue. It is necessary to carry out further research on the incidence rate of AS in Polish population.
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Affiliation(s)
- A Śliwczyński
- Division of Public Health, Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland,
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The heart in rheumatic disease. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00035-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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