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Yilmaz PD, Kadiyoran C, Goktepe MH, Akkubak Y, Icli A, Kucuk A. Syndecan 1 may slow the progression of subclinical atherosclerosis in patients with ankylosing spondylitis. Clin Exp Hypertens 2023; 45:2156529. [DOI: 10.1080/10641963.2022.2156529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Pinar Diydem Yilmaz
- Department of Radiology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Cengiz Kadiyoran
- Department of Radiology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mevlut Hakan Goktepe
- Department of Internal Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Yasemin Akkubak
- Department of Physiotherapy and Rehabilitation, Necmettin Erbakan University, Faculty of Health Sciences, Konya, Turkey
| | - Abdullah Icli
- Department of Cardiology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Adem Kucuk
- Department of Rheumatology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Why and How Should We Assess the Cardiovascular Risk in Patients with Juvenile Idiopathic Arthritis? A Single-Centre Experience with Carotid Intima-Media Measurements. CHILDREN 2023; 10:children10030422. [PMID: 36979980 PMCID: PMC10047782 DOI: 10.3390/children10030422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 02/24/2023]
Abstract
Background: Children diagnosed with juvenile idiopathic arthritis (JIA) are thought to be more likely to develop cardiovascular disease in adulthood. The factors modulating the cardiovascular risk, involving exposure to secondhand smoking, sedentary lifestyle and abnormal body mass index, might have had a stronger impact during the COVID-19 pandemic. The lack of reliable prognostic markers for a higher probability of cardiovascular events might be solved by carotid intima-media thickness (cIMT) measurement. The paramount goal of the study was to assess its usefulness in JIA patients. Materials and Methods: The results of cIMT measured by a single physician in 45 children diagnosed with JIA were compared to 37 age- and sex-matched healthy counterparts. The analysis also involved anthropometric parameters, laboratory tests, and a survey regarding lifestyle-related factors. Results: Four JIA patients appeared to have cIMT above the 94th percentile. A positive correlation between erythrocytes sedimentation rate (ESR) and right carotid artery percentiles was found. Passive smoking increased the cardiovascular risk regardless of JIA. Doubling the daily screen time during the pandemic led to a significant reduction in children’s physical activity. However, the number of enrolled subjects was not enough to make significant recommendations. Conclusions: cIMT measurements remain an interesting perspective for future cardiovascular screening of children with JIA. It has yet to be determined whether it should be considered in all JIA patients on a reliable basis.
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Patterns of dyslipidemia in young patients with seronegative spondyloarthropathies without cardiovascular diseases. Reumatologia 2021; 59:285-291. [PMID: 34819702 PMCID: PMC8609379 DOI: 10.5114/reum.2021.110610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives Patients with seronegative spondyloarthritis (SpA) – psoriatic arthritis (PsA) and ankylosing spondylitis (AS) – have a higher risk of cardiovascular morbidity and mortality. The aim of the present study was to evaluate the incidence and type of dyslipidemia, a potent atherosclerosis risk factor, in SpA patients. Material and methods It was a two-center, case-control study. Patients diagnosed with PsA and AS aged 23–60 years, with disease duration < 10 years, were enrolled. The inflammatory activity, serum levels of C-reactive protein (CRP) and lipid profile were evaluated in each patient. In patients > 40 years old, the 10-year risk of fatal cardiovascular disease (CVD), using Systematic Coronary Risk Evaluation (SCORE), was estimated. Results In total 79 patients with SpA were included in the study, with PsA diagnosed, n = 39 (mean age 45.1 ±9.6 years; 21, 53.9%, women), and with AS diagnosed, n = 40 (age 40.3 ±9.5; 12.3%, women), control group (CG): n = 88 (age 42.3 ±8.1; 42, 47.7% women). Based on the interview and laboratory tests, dyslipidemia was diagnosed in 19 (47.5%) patients with AS and in 28 (71.8%) patients with PsA. Most patients had hypercholesterolemia or mixed hyperlipidemia. Types of dyslipidemia were similar. In SpA patients (PsA and AS), the level of triglycerides (TG) and atherogenic index (AI) were significantly higher than in the CG, respectively TG in SpA: 116 (83–156) and in the CG: 91.2 (72.6–134.6) mg/dl, p = 0.0182; AI in SpA: 3.77 ±1.26 and in the CG: 2.58 ±1.27, p < 0.0001. The low-density cholesterol (LDL) level was significantly lower in SpA patients than in the CG, SpA: 109.1 ±29.4 vs. CG: 125.2 ±35.9 mg/dl, p = 0.0023. There was a strong negative correlation between CRP levels and HDL cholesterol levels in patients with PsA, rho = 0.42, p = 0.0132. Mean SCORE values were 2.33% in PsA patients and 2.38% in AS patients, which results in moderate 10-year risk of death from CVD. Conclusions In young patients with spondyloarthropathies, inflammatory factors significantly influence dyslipidemia patterns, which result in higher TG and lower LDL cholesterol levels. In patients with PsA, dyslipidemia was diagnosed more often than in patients with AS.
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Carotid Artery Pathology in Inflammatory Diseases. Am J Med Sci 2021; 363:209-217. [PMID: 34785170 DOI: 10.1016/j.amjms.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/06/2021] [Accepted: 11/10/2021] [Indexed: 11/22/2022]
Abstract
There is considerable evidence that patients with inflammatory conditions are at higher risk of developing cardiovascular (CV) disease including carotid artery stenosis. CV disease accounts for 35-50% of the excess mortality in patients with inflammatory diseases such as rheumatoid arthritis, with cerebrovascular disease being the second leading cause of death. We review current evidence regarding the association of inflammatory conditions and specifically carotid artery disease. Clinical epidemiological observations suggest that mechanisms other than classic risk factors may promote accelerated atherogenesis in rheumatoid and other inflammatory arthritis and carotid artery disease is increased in individuals with these conditions. Additional studies to better understand the underlying mechanisms and targeted strategies to mitigate such risk are indicated. For now, lifestyle modifications, aggressive treatment of risk factors and lipid lowering therapy in appropriate individuals is indicated.
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González Mazón I, Rueda-Gotor J, Ferraz-Amaro I, Genre F, Corrales A, Calvo Rio V, Palmou Fontana N, Portilla V, Llorca J, Mata C, Hernández-Hernández V, Quevedo-Abeledo JC, Rodríguez-Lozano C, Lopez Medina C, Ladehesa-Pineda ML, Castañeda S, Vicente EF, Fernández-Carballido C, Martínez-Vidal MP, Castro-Corredor D, Anino-Fernández J, Peiteado D, Plasencia-Rodríguez C, García-Vivar ML, Galíndez-Agirregoikoa E, Montes Perez E, Fernández Díaz C, Blanco R, González-Gay MA. Subclinical atherosclerotic disease in ankylosing spondylitis and non-radiographic axial spondyloarthritis. A multicenter study on 806 patients. Semin Arthritis Rheum 2021; 51:395-403. [PMID: 33607385 DOI: 10.1016/j.semarthrit.2021.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/31/2020] [Accepted: 02/06/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To compare the atherosclerosis disease burden between ankylosing spondylitis (AS) and non-radiographic (nr) axial spondyloarthritis (axSpA) and establish a model that allows to identify high-cardiovascular (CV) risk in axial spondyloarthritis patients. METHODS Cross-sectional study from the AtheSpAin cohort, a Spanish multicenter cohort aimed to study atherosclerosis in axSpA. Carotid ultrasound (US) was performed to determine the carotid intima-media wall thickness (cIMT) and detect the presence of carotid plaques. The European cardiovascular disease risk assessment model, the Systematic COronary Risk Evaluation (SCORE), was also applied. RESULTS A set of 639 patients with AS and 167 patients with nr-axSpA without history of CV events were recruited. AS patients were older showing more CV risk factors and higher values of C reactive protein and erythrocyte sedimentation rate (ESR) than those with nr-axSpA. However, no difference in the prevalence of carotid plaques or in the cIMT was found between both groups in the adjusted analysis. The percentage of patients reclassified from the low and moderate CV risk categories to the very high-risk category due to the presence of carotid plaques was comparable in AS and nr-axSpA (10.7% versus 10.1% and 40.5% versus 45.5%, respectively). A model containing age, BASFI and ESR applied to moderate risk axSpA patients identified 41% of these patients as having very high-risk patients with high specificity (88%). CONCLUSION The atherosclerosis burden is similar in nr-axSpA and AS. As occurred for AS, more than 40% of axSpA patients included in the category of moderate CV risk according to the SCORE are reclassified into very high risk after carotid US, and a clinically relevant proportion of them can be detected by applying a model containing age, BASFI and ESR.
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Affiliation(s)
- Iñigo González Mazón
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Javier Rueda-Gotor
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Av. de Valdecilla, 25, 39008 Santander, Cantabria, Spain.
| | - Iván Ferraz-Amaro
- Rheumatology Division, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Fernanda Genre
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, Santander, Spain
| | - Alfonso Corrales
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Av. de Valdecilla, 25, 39008 Santander, Cantabria, Spain
| | - Vanesa Calvo Rio
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Natalia Palmou Fontana
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Virginia Portilla
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Javier Llorca
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, Santander, Spain.
| | - Cristina Mata
- Rheumatology Division, Hospital Comarcal, Laredo, Cantabria, Spain
| | | | - Juan Carlos Quevedo-Abeledo
- Rheumatology Division, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain.
| | - Carlos Rodríguez-Lozano
- Rheumatology Division, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain.
| | | | | | - Santos Castañeda
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain.
| | - Esther F Vicente
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain.
| | | | | | - David Castro-Corredor
- Rheumatology Division, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
| | | | | | | | | | | | | | | | - Ricardo Blanco
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Av. de Valdecilla, 25, 39008 Santander, Cantabria, Spain.
| | - Miguel Angel González-Gay
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Av. de Valdecilla, 25, 39008 Santander, Cantabria, Spain; School of Medicine, University of Cantabria, Santander, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
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Fotoh DS, Serag DM, Badr IT, Saif DS. Prevalence of Subclinical Carotid Atherosclerosis and Vitamin D Deficiency in Egyptian Ankylosing Spondylitis Patients. Arch Rheumatol 2021; 35:335-342. [PMID: 33458656 PMCID: PMC7788658 DOI: 10.46497/archrheumatol.2020.7694] [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] [Received: 06/30/2019] [Accepted: 10/05/2019] [Indexed: 12/23/2022] Open
Abstract
Objectives This study aims to investigate the relationship between subclinical carotid atherosclerosis and vitamin D deficiency in Egyptian ankylosing spondylitis (AS) patients and their impact on disease activity. Patients and methods This cross-sectional study included 40 AS patients (36 males, 4 females; mean age 45.9±8.4 years; range 33 to 55 years) diagnosed according to the 1984 modified New York criteria with equal number of healthy controls (26 males, 14 females; mean age 48.4±7.8 years; range 31 to 55 years). Patients' histories were taken and clinical examinations were performed. Disease activity was assessed with Bath AS metrology index (BASMI), Bath AS disease activity index (BASDAI), and Bath AS functional index (BASFI) scores. Laboratory evaluation included lipid profile and 25-hydroxyvitamin D [25(OH)D] was determined by enzyme-linked immunosorbent assay. Bilateral carotid intima-media thickness (CIMT) was measured by a high-resolution ultrasound with linear 7-12 MHz transducer. Average of CIMT of right and left common carotid arteries was used. Results Statistically significant differences were found between patients and controls in terms of CIMT (p<0.001), 25(OH)D3 (p<0.001) and triglycerides (p=0.02). A significant positive correlation was present between CIMT and disease duration (r=0.74), disease activity scores [BASFI (r=0.60), BASMI (r=0.49), BASDAI (r=0.65)] and lipid profile except for high-density lipoprotein (HDL) that had a negative correlation (r=-0.52). A significant negative correlation was present between 25(OH)D3 levels and CIMT (r=-0.38) and lipid profile except for HDL having a positive correlation (r=0.40). Conclusion Prevalence of subclinical carotid atherosclerosis in AS patients compared to the healthy population was associated with high disease activity and functional limitations. In AS patients, 25(OH)D3 deficiency is a risk factor for accelerated atherosclerosis.
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Affiliation(s)
- Dina Salem Fotoh
- Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Dena Mamdouh Serag
- Department of Radiology, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Ismail Tawfeek Badr
- Department of Orthopedic, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Dalia Salah Saif
- Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
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Assessment of subclinical atherosclerotic cardiovascular disease in patients with ankylosing spondylitis. Anatol J Cardiol 2020; 22:185-191. [PMID: 31584431 PMCID: PMC6955072 DOI: 10.14744/anatoljcardiol.2019.13367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: The aim of the present study was to compare patients with ankylosing spondylitis (AS) with healthy controls with respect to subclinical atherosclerotic cardiovascular disease (CVD). Methods: A total of 44 patients with AS with no history of CVD, diabetes mellitus, hypertension, chronic kidney disease, and lipid-lowering drug use were compared with 40 age- and sex-matched healthy controls with respect to carotid intima-media thickness (CIMT) and pulse wave velocity (PWV), which are surrogate markers of subclinical atherosclerosis. Correlation analysis was also performed to examine the association between surrogate markers and disease activity with inflammation [Ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP)]. Results: In addition to age and sex, both groups were comparable with respect to cigarette smoking, body mass index, and high-density lipoprotein cholesterol (p=0.425, p=0.325, and p=0.103, respectively). The level of total cholesterol was significantly lower in patients with AS (p=0.002). Nonsteroidal anti-inflammatory drug and tumor necrosis factor alpha inhibitor use ratios in patients with AS were 79.5% and 65.9%, respectively. There was no significant difference between both groups regarding PWV and CIMT (p=0.788 and p=0.253, respectively). In patients with AS, there was a significant correlation between ASDAS-CRP and CIMT (r=0.315, p=0.038), but the correlation between ASDAS-CRP and PWV was not significant (r=−0.183, p=0.234). Conclusion: The results of the present study could not provide sufficient evidence whether disease activity with inflammation caused subclinical atherosclerotic CVD in patients with AS without overt CVD. The increased atherosclerotic CVD risk is most probably multifactorial in patients with AS, but the extent of the contribution of disease activity with inflammation to increased atherosclerosis is controversial.
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Khanna NN, Jamthikar AD, Araki T, Gupta D, Piga M, Saba L, Carcassi C, Nicolaides A, Laird JR, Suri HS, Gupta A, Mavrogeni S, Kitas GD, Suri JS. Nonlinear model for the carotid artery disease 10-year risk prediction by fusing conventional cardiovascular factors to carotid ultrasound image phenotypes: A Japanese diabetes cohort study. Echocardiography 2019; 36:345-361. [PMID: 30623485 DOI: 10.1111/echo.14242] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/04/2018] [Indexed: 12/11/2022] Open
Abstract
MOTIVATION This study presents a novel nonlinear model which can predict 10-year carotid ultrasound image-based phenotypes by fusing nine traditional cardiovascular risk factors (ethnicity, gender, age, artery type, body mass index, hemoglobin A1c, hypertension, low-density lipoprotein, and smoking) with five types of carotid automated image phenotypes (three types of carotid intima-media thickness (IMT), wall variability, and total plaque area). METHODOLOGY Two-step process was adapted: First, five baseline carotid image-based phenotypes were automatically measured using AtheroEdge™ (AtheroPoint™ , CA, USA) system by two operators (novice and experienced) and an expert. Second, based on the annual progression rates of cIMT due to nine traditional cardiovascular risk factors, a novel nonlinear model was adapted for 10-year predictions of carotid phenotypes. RESULTS Institute review board (IRB) approved 204 Japanese patients' left/right common carotid artery (407 ultrasound scans) was collected with a mean age of 69 ± 11 years. Age and hemoglobin were reported to have a high influence on the 10-year carotid phenotypes. Mean correlation coefficient (CC) between 10-year carotid image-based phenotype and age was improved by 39.35% in males and 25.38% in females. The area under the curves for the 10-year measurements of five phenotypes IMTave10yr , IMTmax10yr , IMTmin10yr , IMTV10yr , and TPA10yr were 0.96, 0.94, 0.90, 1.0, and 1.0. Inter-operator variability between two operators showed significant CC (P < 0.0001). CONCLUSIONS A nonlinear model was developed and validated by fusing nine conventional CV risk factors with current carotid image-based phenotypes for predicting the 10-year carotid ultrasound image-based phenotypes which may be used risk assessment.
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Affiliation(s)
- Narendra N Khanna
- Department of Cardiology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Ankush D Jamthikar
- Department of Electronics and Communication Engineering, Visvesvaraya National Institute of Technology, Nagpur, India
| | - Tadashi Araki
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Deep Gupta
- Department of Electronics and Communication Engineering, Visvesvaraya National Institute of Technology, Nagpur, India
| | - Matteo Piga
- Department of Rheumatology, University Clinic and AOU of Cagliari, Cagliari, Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Carlo Carcassi
- Department of Genetics, University of Cagliari, Cagliari, Italy
| | - Andrew Nicolaides
- Department of Vascular Surgery, Imperial College, London, UK.,Vascular Diagnostic Center, University of Cyprus, Nicosia, Cyprus
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, California
| | | | - Ajay Gupta
- Department of Radiology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical Center, New York, New York
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Center, Athens, Greece
| | - George D Kitas
- Arthritis Research UK Centre for Epidemiology, Manchester University, Manchester, UK.,Director of Research & Development-Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPointTM, Roseville, California
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Yuan Y, Yang J, Zhang X, Han R, Chen M, Hu X, Ma Y, Wu M, Wang M, Xu S, Pan F. Carotid Intima-Media Thickness in Patients with Ankylosing Spondylitis: A Systematic Review and Updated Meta-Analysis. J Atheroscler Thromb 2018; 26:260-271. [PMID: 30089757 PMCID: PMC6402883 DOI: 10.5551/jat.45294] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: Inflammatory arthritis (IA) diseases are relevant with subclinical atherosclerosis, but the data in ankylosing spondylitis (AS) were inconsistent. Therefore, we performed this meta-analysis to explore the relationship between the marker of subclinical atherosclerosis (carotid intima-media thickness (IMT)) and AS. Methods: We performed a systematic literature review using PubMed, Web of Science, Chinese National Knowledge Infrastructure (CNKI) and Chinese Biomedical Database (CBM) databases up to March 2018. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated to assess the association between carotid IMT and AS. Subgroup analysis, sensitivity analysis, and meta-regression were applied to explore the sources of heterogeneity, and publication bias was calculated to access the quality of pooled studies. Results: A total of 24 articles were collected. The carotid IMT was significantly increased in AS compared with healthy controls (SMD = 0.725, 95% CI = 0.443–1.008, p < 0.001). Subgroup analyses showed the Bath Ankylosing Spondylitis Activity Index (BASDAI) was the source of heterogeneity. Notably, IMT was not significantly increased in those studies that included > 50% patients treated with anti-TNF. Meta-regression revealed severe inflammation status (BASDAI and C-reactive protein (CRP)) could significantly impact carotid IMT in AS. Conclusions: Carotid IMT was significantly increased in patients with AS compared with healthy controls, which suggested subclinical atherosclerosis is related to AS.
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Affiliation(s)
- Yaping Yuan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Jiajia Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Xu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Renfang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Mengya Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Xingxing Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Meng Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Mengmeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Shengqian Xu
- Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
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Zardi EM, Pipita ME, Giorgi C, Lichinchi D, Zardi DM, Afeltra A. Differences in carotid atherosclerosis between patients with ankylosing spondylitis treated with tumor necrosis factor-α antagonists and healthy matched controls. Medicine (Baltimore) 2018; 97:e11250. [PMID: 29979389 PMCID: PMC6076036 DOI: 10.1097/md.0000000000011250] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
An increased vascular risk is present in patients with ankylosing spondylitis (AS). In this report, we evaluate the presence and grade of atherosclerosis in patients with AS, uninterruptedly treated with tumor necrosis factor-α (TNF-α) antagonists for 2 years, in comparison to that in a nontreated group of healthy controls.Fourteen patients with AS and 14 healthy controls underwent carotid sonography to measure intima-media thickness (IMT) and to evaluate the presence of plaque. Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Functional Index scores, erythrocyte sedimentation rate, C-reactive protein, glycemia, total cholesterol, and triglyceride levels were also recorded.Patients with AS showed significantly lower values of mean and maximum IMT at the level of the common carotid (P = .02 and .04, respectively) and the carotid bulb (P = .0006 and .0005, respectively) compared to those of healthy controls. They also had a number of carotid plaques significantly lower than that of healthy controls (P = .02). No differences were found in IMT values at the level of internal carotid between the 2 populations.The significantly lower carotid atherosclerosis found in patients with AS treated with TNF antagonists than in healthy controls shows the important complementary role of this treatment in reducing vascular disease progression probably by decreasing inflammation.
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Affiliation(s)
| | | | - Chiara Giorgi
- Radiology Department, S Maria della Misericordia Hospital, Urbino
| | | | - Domenico Maria Zardi
- Division of Cardiology, Faculty of Medicine and Psychology, University of Rome “Sapienza,” Sant’Andrea Hospital
| | - Antonella Afeltra
- Immunorheumatology Unit, “Campus Bio-Medico” University, Rome, Italy
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Cure E, Icli A, Uslu AU, Sakiz D, Cure MC, Baykara RA, Yavuz F, Arslan S, Kucuk A. Atherogenic index of plasma: a useful marker for subclinical atherosclerosis in ankylosing spondylitis : AIP associate with cIMT in AS. Clin Rheumatol 2018; 37:1273-1280. [PMID: 29435680 DOI: 10.1007/s10067-018-4027-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/27/2018] [Accepted: 02/06/2018] [Indexed: 02/07/2023]
Abstract
Ankylosing spondylitis (AS) is associated with an increased risk of atherosclerotic cardiovascular disease (ACD). The atherogenic index of plasma (AIP), which is the logarithmic transformation of the plasma triglyceride (TG) level to the high-density lipoprotein level (HDL) ratio, has been suggested to be a novel marker in the identification of atherosclerosis risk. Therefore, this study aims to determine if the AIP can act as an accurate marker for the detection of subclinical atherosclerosis. Fifty-two male patients with AS and 52 age-, gender-, and body mass index (BMI)-matched healthy control subjects were included in the study. For each patient, AIP and total cholesterol (TC)/HDL values were calculated and carotid artery intima-media thickness (cIMT) was measured. The mean (SD) cIMT and median (range) AIP values for AS patients were higher than that of the healthy control subjects (0.60 ± 0.18 vs. 0.51 ± 0.10, p = 0.003 and 0.23 [- 0.32 to 0.85] vs. 0.09 [- 0.53 to 0.49], p = 0.007, respectively). A positive correlation was found between the patients' cIMT and AIP values (r = 0.307, p = 0.002) and TC/HDL values (r = 0.241, p = 0.014). Regression analysis revealed an independent association between the subclinical atherosclerosis and AIP (beta [β] = 0.309, p = 0.002). There were no independent correlations between subclinical atherosclerosis and TC (β = 0.245, p = 0.065), TG (β = 0.185, p = 0.515), HDL (β = 0.198, p = 0.231), TC/HDL (β = 0.032, p = 0.862), and low-density lipoprotein (LDL) (β = 0.151, p = 0.246). A strong and independent correlation exists between AIP and cIMT values. Therefore, the AIP could serve as a better marker than the TC/HDL ratio for the detection of subclinical atherosclerosis in AS patients.
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Affiliation(s)
- Erkan Cure
- Department of Internal Medicine, Camlica Erdem Hospital, Istanbul, Turkey.
| | - Abdullah Icli
- Department of Cardiology, Necmettin Erbakan University, Konya, Turkey
| | - Ali Ugur Uslu
- Department of Internal Medicine, Yunus Emre State Hospital, Eskisehir, Turkey
| | - Davut Sakiz
- Department of Endocrinology and Metabolism, Diskapi Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Medine Cumhur Cure
- Department of Biochemistry, Istanbul Laboratory, Mecidiyekoy, Istanbul, Turkey
| | - Rabia Aydogan Baykara
- Department of Physical Medicine and Rehabilitation, Malatya Training and Research Hospital, Malatya, Turkey
| | - Fatma Yavuz
- Department of Internal Medicine, Dogubeyazit Doc. Dr. Yasar Eryilmaz State Hospital, Agri, Turkey
| | - Sevket Arslan
- Division of Allergy and Clinical Immunology, Konya Training and Research Hospital, Konya, Turkey
| | - Adem Kucuk
- Division of Rheumatology, Department of Internal Medicine, Necmettin Erbakan University, Konya, Turkey
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Kucuk A, Uğur Uslu A, Icli A, Cure E, Arslan S, Turkmen K, Toker A, Kayrak M. The LDL/HDL ratio and atherosclerosis in ankylosing spondylitis. Z Rheumatol 2017; 76:58-63. [PMID: 27312464 DOI: 10.1007/s00393-016-0092-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES In ankylosing spondylitis (AS) patients, cardiac and vascular involvement may manifest as atherosclerosis and coronary artery disease. Systemic inflammation, oxidative stress, increased low-density lipoprotein (LDL) cholesterol and decreased high-density lipoprotein (HDL) cholesterol constitute a significant risk for atherosclerosis. This study investigated the relationship between carotid intima-media thickness (CIMT), LDL/HDL ratio, total oxidant status (TOS; an indicator of oxidative stress) and ischemic modified albumin (IMA; an ischemic marker in AS patients). PATIENTS AND METHODS Sixty AS patients were diagnosed using the Modified New York Criteria; 54 age- and gender-matched participants were included as controls. CIMT, LDL/HDL ratio, TOS and IMA were measured using the most appropriate methods. RESULTS IMA was higher in AS patients compared to controls (p < 0.0001). TOS was also increased in AS patients (p = 0.005); as was CIMT (p < 0.0001). The LDL/HDL ratio was also greater in AS patients compared to controls (p = 0.047). A positive correlation was found between CIMT and LDL/HDL ratio among AS patients. CONCLUSION Elevated CIMT, IMA and TOS levels suggest an increased risk of atherosclerotic heart disease in AS patients. The LDL/HDL ratio was higher in AS patients compared to controls, and there was a correlation between LDL/HDL ratio and CIMT, albeit statistically weak. Therefore, the LDL/HDL ratio is not a reliable marker to predict atherosclerotic heart disease in AS patients.
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Affiliation(s)
- A Kucuk
- Division of Rheumatology, Department of Internal Medicine, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey.
| | - A Uğur Uslu
- Eskişehir Military Hospital, Eskisehir, Rize, Turkey
| | - A Icli
- Necmettin Erbakan University, Konya, Turkey
| | - E Cure
- Recep Tayyip Erdogan University, Rize, Turkey
| | - S Arslan
- Necmettin Erbakan University, Konya, Turkey
| | - K Turkmen
- Necmettin Erbakan University, Konya, Turkey
| | - A Toker
- Necmettin Erbakan University, Konya, Turkey
| | - M Kayrak
- Necmettin Erbakan University, Konya, Turkey
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13
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Factors associated with accelerated subclinical atherosclerosis in patients with spondyloarthritis without overt cardiovascular disease. Clin Rheumatol 2017; 36:2487-2495. [DOI: 10.1007/s10067-017-3786-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/19/2017] [Accepted: 08/07/2017] [Indexed: 12/14/2022]
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Kucuk A, Uğur Uslu A, Icli A, Cure E, Arslan S, Turkmen K, Toker A, Kayrak M. The LDL/HDL ratio and atherosclerosis in ankylosing spondylitis. Z Rheumatol 2016. [PMID: 27312464 DOI: 10.1007/s00393-016-0092-4.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES In ankylosing spondylitis (AS) patients, cardiac and vascular involvement may manifest as atherosclerosis and coronary artery disease. Systemic inflammation, oxidative stress, increased low-density lipoprotein (LDL) cholesterol and decreased high-density lipoprotein (HDL) cholesterol constitute a significant risk for atherosclerosis. This study investigated the relationship between carotid intima-media thickness (CIMT), LDL/HDL ratio, total oxidant status (TOS; an indicator of oxidative stress) and ischemic modified albumin (IMA; an ischemic marker in AS patients). PATIENTS AND METHODS Sixty AS patients were diagnosed using the Modified New York Criteria; 54 age- and gender-matched participants were included as controls. CIMT, LDL/HDL ratio, TOS and IMA were measured using the most appropriate methods. RESULTS IMA was higher in AS patients compared to controls (p < 0.0001). TOS was also increased in AS patients (p = 0.005); as was CIMT (p < 0.0001). The LDL/HDL ratio was also greater in AS patients compared to controls (p = 0.047). A positive correlation was found between CIMT and LDL/HDL ratio among AS patients. CONCLUSION Elevated CIMT, IMA and TOS levels suggest an increased risk of atherosclerotic heart disease in AS patients. The LDL/HDL ratio was higher in AS patients compared to controls, and there was a correlation between LDL/HDL ratio and CIMT, albeit statistically weak. Therefore, the LDL/HDL ratio is not a reliable marker to predict atherosclerotic heart disease in AS patients.
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Affiliation(s)
- A Kucuk
- Division of Rheumatology, Department of Internal Medicine, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey.
| | - A Uğur Uslu
- Eskişehir Military Hospital, Eskisehir, Rize, Turkey
| | - A Icli
- Necmettin Erbakan University, Konya, Turkey
| | - E Cure
- Recep Tayyip Erdogan University, Rize, Turkey
| | - S Arslan
- Necmettin Erbakan University, Konya, Turkey
| | - K Turkmen
- Necmettin Erbakan University, Konya, Turkey
| | - A Toker
- Necmettin Erbakan University, Konya, Turkey
| | - M Kayrak
- Necmettin Erbakan University, Konya, Turkey
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Arida A, Protogerou AD, Konstantonis G, Konsta M, Delicha EM, Kitas GD, Sfikakis PP. Subclinical Atherosclerosis Is Not Accelerated in Patients with Ankylosing Spondylitis with Low Disease Activity: New Data and Metaanalysis of Published Studies. J Rheumatol 2015; 42:2098-105. [PMID: 26428207 DOI: 10.3899/jrheum.150316] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Chronic inflammatory rheumatic diseases are associated with accelerated atherosclerosis, but data in ankylosing spondylitis (AS) are limited and the relative contribution of inflammation versus classical cardiovascular (CV) risk factors remains a matter of controversy. We addressed this in an original study and a metaanalysis of previous studies. METHODS Atheromatic plaques in carotid and femoral arteries, carotid hypertrophy [intima-media thickness (IMT), cross-sectional area], and carotid stiffness by ultrasound, as well as aortic stiffness by pulse wave velocity, were examined in consecutive nondiabetic, CV disease (CVD)-free patients with AS. Healthy individuals carefully matched 1:1 with patients for age, sex, smoking habits, hyperlipidemia, and hypertension served as controls. A metaanalysis of original studies that examined subclinical atherosclerosis in patients with AS versus controls with comparable CVD risk factors was also performed. RESULTS Carotid and femoral atheromatic plaques were slightly less prevalent compared with controls in a contemporary cohort consisting of 67 patients with AS (82% men), aged 47.5 ± 12.5 years (mean ± SD), with a median disease duration of 12 years and a Bath AS Disease Activity Index (BASDAI) of 1.8 (interquartile range 0.4-3.6), of whom 66% were receiving anti-tumor necrosis factor (TNF) treatment. Carotid hypertrophy and stiffness, as well as aortic stiffness, were similar between patients and their matched controls. Metaanalysis of all published studies revealed a significantly increased carotid IMT, but not plaque burden, in AS versus controls. Notably, however, increased IMT was not evident in studies involving patients with low disease activity (mean BASDAI < 4) or in those studies that included > 50% of patients treated with anti-TNF. CONCLUSION Low AS disease activity is not associated with accelerated atherosclerosis.
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Affiliation(s)
- Aikaterini Arida
- From the Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital; Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School, Athens, Greece.A. Arida, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; A.D. Protogerou, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G. Konstantonis, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; M. Konsta, MD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; E.M. Delicha, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G.D. Kitas, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; P.P. Sfikakis, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School
| | - Athanasios D Protogerou
- From the Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital; Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School, Athens, Greece.A. Arida, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; A.D. Protogerou, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G. Konstantonis, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; M. Konsta, MD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; E.M. Delicha, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G.D. Kitas, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; P.P. Sfikakis, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School
| | - George Konstantonis
- From the Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital; Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School, Athens, Greece.A. Arida, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; A.D. Protogerou, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G. Konstantonis, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; M. Konsta, MD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; E.M. Delicha, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G.D. Kitas, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; P.P. Sfikakis, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School
| | - Maria Konsta
- From the Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital; Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School, Athens, Greece.A. Arida, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; A.D. Protogerou, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G. Konstantonis, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; M. Konsta, MD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; E.M. Delicha, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G.D. Kitas, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; P.P. Sfikakis, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School
| | - Evi M Delicha
- From the Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital; Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School, Athens, Greece.A. Arida, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; A.D. Protogerou, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G. Konstantonis, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; M. Konsta, MD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; E.M. Delicha, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G.D. Kitas, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; P.P. Sfikakis, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School
| | - George D Kitas
- From the Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital; Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School, Athens, Greece.A. Arida, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; A.D. Protogerou, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G. Konstantonis, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; M. Konsta, MD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; E.M. Delicha, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G.D. Kitas, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; P.P. Sfikakis, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School
| | - Petros P Sfikakis
- From the Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital; Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School, Athens, Greece.A. Arida, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; A.D. Protogerou, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G. Konstantonis, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; M. Konsta, MD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; E.M. Delicha, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G.D. Kitas, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; P.P. Sfikakis, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School.
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Verma I, Krishan P, Syngle A. Predictors of Atherosclerosis in Ankylosing Spondylitis. Rheumatol Ther 2015; 2:173-182. [PMID: 27747533 PMCID: PMC4883264 DOI: 10.1007/s40744-015-0017-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Accelerated atherosclerosis associated with an enhanced inflammatory state, which characterizes ankylosing spondylitis (AS), is the leading cause of increased cardiovascular risk. The objective of this study was to assess carotid intima-media thickness (CIMT) as a surrogate for subclinical atherosclerosis in AS patients and its possible correlation with disease-related clinical parameters. METHODS We performed a prospective study of 30 consecutive patients meeting modified New York criteria for AS compared to 25 controls matched for age and sex. Patients with traditional CV risk factors were excluded. Disease-specific measures and inflammatory measures (ESR, CRP, TNF-α, IL-6 and IL-1) were determined. CIMT was measured in the right common carotid artery using high-resolution B-mode ultrasound. RESULTS AS patients exhibited increased CIMT compared to matched healthy controls (0.62 ± 0.12 vs. 0.53 ± 0.09 mm). CIMT was positively correlated with age, disease duration, disease activity (BASDAI and ASDAS) and the inflammatory measures ESR (r = 0.45, P = 0.11) and TNF-α (r = 0.62, P < 0.001). CIMT did not correlate with the BMI, BASFI, IL-6, IL-1 or cholesterol levels. CONCLUSIONS This study shows increased CIMT in AS patients without traditional cardiovascular risk factors compared to healthy controls. An increase in age, disease duration, disease activity (BASDAI and ASDAS), biomarkers of inflammation (ESR and CRP) and TNF-α may predict the occurrence of accelerated atherosclerosis in AS.
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Affiliation(s)
- Inderjeet Verma
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, India
| | - Pawan Krishan
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, India
| | - Ashit Syngle
- Cardio Rheuma and Healing Touch City Clinic, Chandigarh and Rheumatologist Fortis Multi Specialty Hospital, Mohali, India.
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Inci U, Yildiz A, Batmaz I, Tekbas E. Assessment of serum asymmetric dimethylarginine levels and left ventricular diastolic function in patients with ankylosing spondylitis. Int J Rheum Dis 2015; 20:238-244. [PMID: 26012572 DOI: 10.1111/1756-185x.12608] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIM To assess left ventricular diastolic functions and serum dimethylarginine (ADMA) concentrations, as well as the effect of different treatment strategies on ADMA concentrations and diastolic function parameters, in patients with ankylosing spondylitis (AS). METHOD Sixty AS patients and 40 control subjects without classical cardiovascular (CV) risk factors were included in the study. Baseline clinical and echocardiographic variables were obtained. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and ADMA levels were measured. Spinal mobility, disease activity and functional status were assessed using Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index. RESULTS CRP, ESR and ADMA levels were significantly higher in the AS group as compared to the control group. Two (5%) control subjects and six (10%) AS patients met the criteria for left ventricular diastolic dysfunction (DD) on conventional Doppler echocardiography, but the difference was not statistically significant (P = 0.36). However, using tissue Doppler imaging, 12 (20%) patients in the AS group and three (8%) subjects in the control group were diagnosed with left ventricular DD (P = 0.08). The anti-tumor necrosis factor (TNF)-α group, conventional therapy group and control group were compared in terms of ADMA, CRP, ESR levels and echocardiographic parameters. ADMA levels were significantly lower in anti-TNF-α group as compared to the conventional therapy group (P < 0.001). In the control group, ADMA levels were significantly lower than both treatment groups (P < 0.001). CONCLUSION Increased ADMA levels reveal impaired nitric oxide metabolism in a relatively young group of patients with AS, who have no classical CV risk factors. Anti-TNF-α may have beneficial effect on endothelial function in AS patients by reducing ADMA levels.
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Affiliation(s)
- Umit Inci
- Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Abdulkadir Yildiz
- Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Ibrahim Batmaz
- Department of Physical Medicine and Rehabilitation, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Ebru Tekbas
- Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey
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The risk of ischemic stroke in major rheumatic disorders. J Neuroimmunol 2014; 277:1-5. [PMID: 25266144 DOI: 10.1016/j.jneuroim.2014.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/12/2014] [Accepted: 09/13/2014] [Indexed: 02/08/2023]
Abstract
Rheumatic disorders (RD) are a range of conditions associated with inflammation of joints and connective tissue. They can manifest beyond the musculoskeletal system. Recent focus has been placed on the association of ischemic stroke with these conditions. Traditional vascular risk factors seem to be more prevalent in patients with certain types of RD than in the general population, but these factors do not fully explain the enhanced vascular risk in this population. Four major RD will be discussed in terms of their relationship with ischemic stroke: rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, and psoriatic arthritis.
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Drug retention rates and treatment discontinuation among anti-TNF-α agents in psoriatic arthritis and ankylosing spondylitis in clinical practice. Mediators Inflamm 2014; 2014:862969. [PMID: 25110401 PMCID: PMC4119698 DOI: 10.1155/2014/862969] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/26/2014] [Accepted: 05/29/2014] [Indexed: 01/19/2023] Open
Abstract
Objective. The study aim was to determine treatment persistence rates and to identify causes of discontinuation in psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients in clinical practice. Methods. Patients treated with adalimumab (ADA), etanercept (ETA), or infliximab (INF) were retrospectively included. Treatment persistence rates were analyzed by means of a stepwise logistic regression. Differences between therapy duration were assessed by means of an analysis of variance model (ANOVA), while a chi-square test was used to evaluate relationships between therapies and causes of treatment discontinuation and the administration of concomitant disease-modifying antirheumatic drugs (DMARDs) among therapies and types of disease considering completed courses of therapy versus courses that were discontinued. Results. 268 patients received a total of 353 anti-TNF treatment courses (97 ADA, 180 ETA, and 76 INF). Comparison among therapies showed significant difference regarding the treatment persistence rates due to the contrast between ETA and INF (P = 0.0062). We observed that 84.7% of patients were still responding after 6 months of follow-up. Comparison among diseases showed that there were significant differences between PsA and AS (P = 0.0073) and PsA and PsA with predominant axial involvement (P = 0.0467) in terms of duration of the therapy, while there were no significant differences with regard to the persistence rate. Conclusions. In this cohort, anti-TNF-α therapy was associated with high drug persistence rates. As in rheumatoid arthritis, switching to another anti-TNF-α agent can be an effective option when, during the treatment of AS or PsA, therapy is suspended because of inefficacy or an adverse event. Combination therapy with DMARDs was associated with a better persistence rate.
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Ibrahim HA, Mohammed MO, Dhahir HAR, Mahmood KA, Nuradeen BE. Impact of <i>Helicobacter pylori</i> Infection on Serum Lipid Profile and Atherosclerosis of Carotid Artery. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ijcm.2014.515125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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