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Sen R, Caplan L, Danila MI. Cardiovascular disease in spondyloarthritis: a narrative review of risk factors and the effect of treatments. Curr Opin Rheumatol 2024; 36:95-107. [PMID: 38126207 DOI: 10.1097/bor.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the recent evidence available regarding the epidemiology of cardiovascular disease in spondyloarthritis (SpA), including the effect of disease modifying drugs on cardiovascular risk. RECENT FINDINGS People with SpA suffer from an increased risk of cardiovascular disease compared to the general population. This elevated risk is explained by the high prevalence of traditional cardiovascular risk factors and inflammation from disease activity leading to endothelial dysfunction and accelerated atherosclerosis. Consequently, the American College of Cardiology/American Heart Association and the European League Against Rheumatism recommend enhanced cardiovascular risk screening in SpA patients. There is evidence from observational studies that methotrexate and tumor necrosis factor inhibitors reduce the risk of cardiovascular events in SpA. Unlike what is observed in the general population, the use of nonsteroidal anti-inflammatory drugs does not appear to increase cardiovascular disease risk in SpA. SUMMARY Cardiovascular diseases are increasingly recognized in patients suffering from SpA, especially axial SpA and psoriatic arthritis. Cardiovascular diseases can cause significant morbidity, mortality, and add to the overall disease burden. Disease modifying drugs may mitigate some of the cardiovascular risk; however, a multidisciplinary team is needed to monitor patients and improve cardiovascular health status.
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Affiliation(s)
- Rouhin Sen
- The University of Alabama Birmingham, Division of Clinical Immunology and Rheumatology
- Birmingham Veterans Affairs Medical Center (VAMC), Birmingham, Alabama
| | - Liron Caplan
- Rocky Mountain Regional VAMC
- University of Colorado, Division of Rheumatology, Aurora, Colorado, USA
| | - Maria I Danila
- The University of Alabama Birmingham, Division of Clinical Immunology and Rheumatology
- Birmingham Veterans Affairs Medical Center (VAMC), Birmingham, Alabama
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Shi LH, Lam SH, So H, Chan CY, Li TK, Szeto CC, Tam LS. Inflammation is associated with incident hypertension in patients with axial spondyloarthritis: A longitudinal cohort study. Clin Exp Hypertens 2023; 45:2205056. [PMID: 37139811 DOI: 10.1080/10641963.2023.2205056] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To elucidate the risk factors for the development of incident hypertension (IHT) in patients with axial spondyloarthritis (axSpA). METHODS We conducted a retrospective cohort study in axSpA patients who were recruited from 2001 to 2019 from a university clinic in Hong Kong. Patients with HT and/or anti-hypertensive drug use at baseline were excluded. They were followed until the end of 2020. The outcome was IHT, defined by a diagnosis and a prescription for an antihypertensive drug. Baseline and time-varying Cox regression analyses adjusting for age, sex, and body mass index (BMI), were used to assess the relationship between drug use, inflammatory burden, and IHT. RESULTS Four hundred and thirteen patients [age: 34(25-43) years, male: 319 (77.2%)] were recruited. After a median follow-up of 12 (6-17) years, 58 patients (14%) developed IHT (IHT+group). Among all the baseline variables, disease duration and delay in diagnosis were the independent predictors for IHT based on the Cox regression model. In the multivariate Cox regression analysis, baseline disease duration, delay in diagnosis and time-varying ESR levels were independent predictors associated with an increased risk of IHT. IHT risk was significantly increased in patients with disease duration >5 years. The use of anti-inflammatory drugs was not associated with the development of IHT. CONCLUSION Higher inflammatory burden as reflected by a longer disease duration, delay diagnosis and higher ESR levels, were predictors associated with IHT after adjusting for traditional CV risk factors. These data support routine screening for hypertension in axSpA patients, especially those with longer disease duration.
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Affiliation(s)
- Lin-Hong Shi
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Li Ka Shing Institute of Health Science (LiHS), The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Steven H Lam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ho So
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Crystal Y Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Tena K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Cheuk-Chun Szeto
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Li Ka Shing Institute of Health Science (LiHS), The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Fakih O, Desmarets M, Martin B, Prati C, Monnet E, Verhoeven F, Wendling D. Difficult-to-treat axial spondyloarthritis is associated with psoriasis, peripheral involvement and comorbidities: results of an observational nationwide study. RMD Open 2023; 9:e003461. [PMID: 37996127 PMCID: PMC10668281 DOI: 10.1136/rmdopen-2023-003461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES To determine the cumulative incidence and identify the factors associated with difficult-to-treat axial spondyloarthritis (D2T-axSpA) in French patients newly benefiting from the French 'long-term illness' (LTI) social security scheme for axial spondyloarthritis (axSpA). METHODS This national cohort study was based on the French National Medico-Administrative Database, SNDS, which contains data on hospitalisation, LTI and outpatient care consumption. All French patients newly receiving LTI benefits for ankylosing spondylitis (AS) between 2010 and 2013 were included in the study. In France, LTI is required to access biological/targeted synthetic DMARDs (b/tsDMARDs). The follow-up period ended on 31 December 2018. So-called D2T-axSpA was defined as the failure of three b/tsDMARDs or of two b/tsDMARDs with different modes of action. Comorbidities and extra-musculoskeletal manifestations were identified using previously described algorithms. Characteristics were compared between patients with D2T-axSpA and patients with non-D2T-axSpA who had received at least one b/tsDMARD with bivariate and multivariate analysis using logistic regression. Incidence rates of major cardiovascular event (MACE) and death were compared using competitive risk analysis. RESULTS 22 932 patients were included. 10 798 (47.08%) patients received at least one bDMARD. None received tsDMARD. During follow-up, 2115 patients were classified as having D2T-axSpA, representing 19.59% of patients who received at least one bDMARD. In multivariate analysis, D2T-axSpA was significantly associated with female gender, peripheral involvement, psoriasis, hypertension and depression (p<0.001 for each case). There was no difference in the incidence of MACE (p=0.92) or death (p=0.87). CONCLUSION D2T-axSpA affects one in five patients exposed to bDMARDs in this national cohort. D2T-axSpA is more common in women and patients with peripheral involvement and/or comorbidities.
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Affiliation(s)
- Olivier Fakih
- Service de rhumatologie, CHU de Besançon, Besançon, France
| | - Maxime Desmarets
- Inserm CIC 1431, CHU de Besançon, Besançon, France
- UMR 1098 Right, Université Bourgogne Franche-Comté, Besancon, France
| | | | - Clement Prati
- Service de rhumatologie, CHU de Besançon, Besançon, France
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Hintenberger R, Affenzeller B, Vladychuk V, Pieringer H. Cardiovascular risk in axial spondyloarthritis-a systematic review. Clin Rheumatol 2023; 42:2621-2633. [PMID: 37418034 PMCID: PMC10497445 DOI: 10.1007/s10067-023-06655-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 07/08/2023]
Abstract
Cardiovascular manifestations are common in patients suffering axial spondyloarthritis and can result in substantial morbidity and disease burden. To give an overview of this important aspect of axial spondyloarthritis, we conducted a systematic literature search of all articles published between January 2000 and 25 May 2023 on cardiovascular manifestations. Using PubMed and SCOPUS, 123 out of 6792 articles were identified and included in this review. Non-radiographic axial spondyloarthritis seems to be underrepresented in studies; thus, more evidence for ankylosing spondylitis exists. All in all, we found some traditional risk factors that led to higher cardiovascular disease burden or major cardiovascular events. These specific risk factors seem to be more aggressive in patients with spondyloarthropathies and have a strong connection to high or long-standing disease activity. Since disease activity is a major driver of morbidity, diagnostic, therapeutic, and lifestyle interventions are crucial for better outcomes. Key Points • Several studies on axial spondyloarthritis and associated cardiovascular diseases have been conducted in the last few years addressing risk stratification of these patients including artificial intelligence. • Recent data suggest distinct manifestations of cardiovascular disease entities among men and women which the treating physician needs to be aware of. • Rheumatologists need to screen axial spondyloarthritis patients for emerging cardiovascular disease and should aim at reducing traditional risk factors like hyperlipidemia, hypertension, and smoking as well as disease activity.
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Affiliation(s)
- Rainer Hintenberger
- Department for Internal Medicine II, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstraße 9, 4020 Linz and Altenbergerstraße 69, 4040, Linz, Austria.
| | - Barbara Affenzeller
- Department for Internal Medicine II, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstraße 9, 4020 Linz and Altenbergerstraße 69, 4040, Linz, Austria
| | - Valeriia Vladychuk
- Department for Internal Medicine II, Kepler University Hospital GmbH, Krankenhausstraße 9, 4020, Linz, Austria
| | - Herwig Pieringer
- Diakonissen Hospital Linz, Linz, Austria and Paracelsus Private Medical University Salzburg, Salzburg, Austria
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Bodur H. Cardiovascular comorbidities in spondyloarthritis. Clin Rheumatol 2023; 42:2611-2620. [PMID: 36512164 DOI: 10.1007/s10067-022-06473-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022]
Abstract
In recent years, many researchers have focused on the development of comorbidities associated with axial spondyloarthritis. Hypertension, smoking, dyslipidemia, diabetes mellitus, obesity, and the presence of inflammation, which is a well-known risk factor, increase cardiovascular comorbidities. Previous studies reported that HLA-B27 might be a genetic risk factor for various cardiac conditions. In the treatment and follow-up, raising the awareness of cardiovascular risk and guiding clinical practice and future research in rheumatic and musculoskeletal diseases should be aimed. There is consensus that cardiovascular risks should be evaluated periodically in these patients, particularly during the course of treatment. A decision regarding the selection and follow-up protocols of the drugs should be made considering all the risks and benefits in spondyloarthropathies. In this review, we discussed the recommendations and practices for the management of cardiovascular comorbidities in axial spondyloarthritis. Key Points • The risk of cardiovascular morbidity and mortality is increased in axial spondyloarthritis. • Higher disease activity increases cardiovascular risk factors. • Axial spondyloarthritis patients should be carefully monitored for signs of cardiovascular events as this is necessary to ensure that patients are treated appropriately and awareness should be raised in all patients. • Reducing the activity of the underlying disease with an appropriate and early treatment will also reduce the risk of cardiovascular events.
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Affiliation(s)
- Hatice Bodur
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Türkiye.
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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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Hušáková M, Levitová A, Domluvilová D, Dad’ová K, Pavelka K. Depression and anxiety in individuals with axial spondyloarthritis and nonspecific low back pain who are interested in non-pharmacological therapy options: Cross-sectional study. Medicine (Baltimore) 2022; 101:e30866. [PMID: 36181028 PMCID: PMC9524985 DOI: 10.1097/md.0000000000030866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Psychological burden, such as depression and anxiety, may be associated with axial spondyloarthritis (axSpA) and poor prognosis of nonspecific low back pain (NSLBP). Non-pharmacological therapy is a substantial part of the management of both illnesses. Our study describes the psychological outcomes in patients with axSpA and NSLBP who were actively looking for non-pharmacological therapy. A total of 60 participants (34 with axSpA and 26 with NSLBP) were included in this cross-sectional study. Anxiety and depression were examined using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI-II), respectively. The relationships between BAI and BDI-II and quality of life (EQ-5D), pain intensity (NRS pain), disease activity (AS disease activity score, ASDAS-CRP), and function (Bath AS Functional Index, BASFI) were determined. The intensity of anxiety and depression did not differ between patients with and without axSpA. In both, axSpA and NSLBP, BAI, and BDI-II scores were inversely correlated with EQ-5D, R = -0.268 (P ˂ .05) and R = -0.486 (P ˂ .0001), respectively. We found a variation in the relationship between pain intensity and psychological outcomes in NSLBP and axSpA. The pain intensity score was correlated with the BDI-II (R = 0.542, P = .001) and BAI (R = 0.489, P = .003) scores only in patients with axSpA. In patients with axSpA, BAI was inversely correlated with disease duration (R = -0.356, P = .039) and positively correlated with increased disease activity and poor function, ASDAS-CRP (R = 0.431, P = .012) and BASFI (R = 0.621, P ˂ .0001) scores. The ASDAS-CRP score was positively correlated with BDI-II (R = 0.562, P = .001), and both disease activity and female sex were identified as risk factors for poor BDI-II outcomes in axSpA patients according to multiple regression analysis. Experiences of anxiety and depression seem to be similar for patients with axSpA and NSLBP in this selected group of participants. However, pain intensity may influence psychological outcomes, mainly in patients with axSpA. Disease activity, impaired function, and female sex were risk factors for anxiety and depression in patients with axSpA.
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Affiliation(s)
- Markéta Hušáková
- Institute of Rheumatology, Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
- *Correspondence: Markéta Hušáková, Institute of Rheumatology, Na Slupi 4, 128 50 Praha 2, Czech Republic (e-mail: )
| | - Andrea Levitová
- Faculty of Physical Education and Sport, Department of Adapted Physical Education and Sports Medicine, Charles University, Prague, Czech Republic
| | - Daniela Domluvilová
- First Faculty of Medicine, Department of Psychiatry, Charles University in Prague and General Hospital in Prague, Prague, Czech Republic
| | - Klára Dad’ová
- Faculty of Physical Education and Sport, Department of Adapted Physical Education and Sports Medicine, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
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Nonsteroidal anti-inflammatory drugs and cardiovascular disease risk in spondyloarthritis-spectrum diseases. Curr Opin Rheumatol 2022; 34:203-208. [PMID: 35762631 DOI: 10.1097/bor.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Increased cardiovascular (CV) risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs) is well recognized in the general population. This may limit the use of this effective therapy in patients with spondyloarthritis (SpA), a population already at high CV risk. RECENT FINDINGS Increased CV diseases and their risk factors in patients with SpA were consistently shown in recent population-level data. NSAIDs remained commonly prescribed in SpA, though their structural benefit remained controversial and the dispensing practice was variable in different regions in the world. A previous observation study suggested NSAIDs in SpA might be cardio-protective, possibly via their modulation of the chronic inflammatory state. A recent meta-analysis of nonrandomized studies also revealed no increased risk of a CV event. Interestingly, there is growing evidence that different NSAIDs might impose differential CV risk on patients with SpA. SUMMARY Recent evidence suggested NSAIDs were associated with a neutral and possibly lower CV risk in patients with SpA, which provided some reassurance for their use.
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Magrey M, Schwartzman S, de Peyrecave N, Sloan VS, Stark JL. Nonradiographic axial spondyloarthritis: expanding the spectrum of an old disease: A narrative review. Medicine (Baltimore) 2022; 101:e29063. [PMID: 35475794 PMCID: PMC9276084 DOI: 10.1097/md.0000000000029063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/24/2022] [Indexed: 01/04/2023] Open
Abstract
Nonradiographic axial spondyloarthritis (nr-axSpA) represents a distinct phenotype within the spectrum of axial spondyloarthritis (axSpA), which is characterized by a range of clinical manifestations. Despite a high disease burden that is comparable to ankylosing spondylitis (also known as radiographic axSpA), there is an unmet need to recognize and effectively manage patients with active nr-axSpA.A targeted literature search was conducted in OVID (MEDLINE and Embase databases) to identify articles on nr-axSpA, including its definition, demographics, epidemiology, burden, diagnosis, clinical presentation, and treatment guidelines.The lack of adequate epidemiological data and incomplete understanding of nr-axSpA among rheumatologists and nonrheumatologists contributes to delayed referrals and diagnosis. This delay results in a substantial burden on patients, physically and psychologically, and the healthcare system. Targeted therapies, such as biologics, including inhibitors of tumor necrosis factor or interleukin-17A, have been approved and utilized for the management of nr-axSpA, and other novel therapeutics with different mechanisms of action are in development. Raising awareness among US internists regarding the prevalence of nr-axSpA, disease burden, clinical presentation, diagnostic tools, and available treatments is important for improved disease management.Future clinical investigations focusing on the development of markers that aid early diagnosis and predict treatment response may also improve the management of nr-axSpA. This review provides an overview of nr-axSpA with the aim of raising awareness of the disease among US internists, with an overarching goal to contribute toward the improved recognition and timely referral of these patients to rheumatologists for diagnosis and management.
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Affiliation(s)
- Marina Magrey
- Case Western Reserve University School of Medicine at MetroHealth Medical Center, Department of Medicine, Division of Rheumatology, Cleveland, OH
- University Hospitals Cleveland Medical Center School of Medicine, Division of Rheumatology, Cleveland, OH
| | | | | | - Victor S. Sloan
- Sheng Consulting LLC, Flemington, NJ
- Rutgers Robert Wood Johnson Medical School, Division of Rheumatology and Connective Tissue Research, New Brunswick, NJ
- The Peace Corps, Washington, DC
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Clinical Features and Drug Retention of TNF Inhibitors in Older Patients with Ankylosing Spondylitis: Results from the KOBIO Registry. BioDrugs 2022; 36:411-419. [PMID: 35349115 DOI: 10.1007/s40259-022-00524-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVES This study aimed to analyse the clinical features and outcomes of and reasons for discontinuing tumour necrosis factor (TNF) inhibitor therapy in older patients with ankylosing spondylitis (AS). METHODS Data were extracted from the nationwide Korean College of Rheumatology Biologics registry. Clinical variables and outcomes were compared, and drug retention rate was evaluated. RESULTS Among 1524 patients with AS treated with TNF inhibitors, 306 were aged ≥ 50 years ('older patients'). Fewer patients were male, the incidence of hypertension and diabetes was higher (all p < 0.001), and the proportion of peripheral arthritis (35.6 vs. 27.1%), Ankylosing Spondylitis Disease Activity Score‒erythrocyte sedimentation rate (4.0 ± 1.1 vs. 3.6 ± 1.0), and Bath Ankylosing Spondylitis Functional Index (4.2 ± 2.6 vs. 3.3 ± 2.5) were all higher in older patients. Although the drug retention rate was lower (log-rank p = 0.018) and lack of efficacy and adverse events were more frequent in older patients (both p < 0.001), drug retention rates were not different after propensity score matching (log-rank p = 0.23). Improvements in disease activity and manifestations were comparable between groups, except for the incidence of peripheral arthritis, which decreased significantly less in older patients over 3 and 5 years. CONCLUSION Improvements in disease-related clinical factors and drug retention rates were not different between older and younger patients with AS receiving TNF inhibitors. However, the incidence of adverse events was higher in older patients.
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Maguire S, Fitzgerald G, Gallagher P, O'Shea F. Advances in treatment of axial spondyloarthritis are associated with improved patient outcomes: data from the Ankylosing Spondylitis Registry of Ireland (ASRI). Rheumatol Int 2022; 42:831-838. [PMID: 35088133 DOI: 10.1007/s00296-021-05067-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
The Ankylosing Spondylitis Registry of Ireland (ASRI) captures both radiographic and non-radiographic axial spondyloarthritis (axSpA) in a large, well characterised cohort. This is a valuable resource for studies in therapeutics and burden of disease, following a period of rapid change in the field of axSpA. This study aims to perform a focused analysis on patient outcomes and pattern of medication usage in axSpA. This is a cross-sectional study of registry data on 885 patients with confirmed axSpA as per the ASAS criteria for axSpA, as diagnosed by a Rheumatologist. Analysis was performed using IBM SPSS version 26. Patients were analysed on the basis of treatment categorised as: no medication, NSAIDs, biologics or combination therapy. Statistical significance was indicated by p value of < 0.05. Currently 885 patients are enrolled in the ASRI, made up of 72.5% (642) males and 26.9% (238) females. The majority of the cohort was categorized as radiographic axSpA 78.3% (693), with 21.7% (192) meeting criteria for non-radiographic disease. Overall 40.6% (359) reported at least one comorbidity. Older age was associated with no medications compared to those on biologic therapy (50.3 vs 45, p = 0.01). Lower levels of disease activity and higher quality of life were noted in those on biologics as compared to NSAIDs alone. This analysis provides detailed epidemiological data on axSpA from a large national registry. These results detail significant differences in prescribing patterns and impact on patient outcomes in axSpA. Ongoing development of registries provides a valuable insight into the real-world effects of axSpA.
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Affiliation(s)
- Sinead Maguire
- Department of Rheumatology, St James' Hospital, Dublin, Ireland. .,School of Medicine, Trinity College, Dublin, Ireland.
| | - Gillian Fitzgerald
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
| | - Phil Gallagher
- Department of Rheumatology, St Vincent's Hospital, Dublin, Ireland
| | - Finbar O'Shea
- Department of Rheumatology, St James' Hospital, Dublin, Ireland.,School of Medicine, Trinity College, Dublin, Ireland
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Wan ZH, Wang J, Zhao Q. Acute myocardial infarction in a young man with ankylosing spondylitis: A case report. World J Clin Cases 2021; 9:11392-11399. [PMID: 35071570 PMCID: PMC8717491 DOI: 10.12998/wjcc.v9.i36.11392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/29/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease that mainly affects the spine and sacroiliac joints. To the best of our knowledge, AS with acute myocardial infarction (AMI) has rarely been reported. Here, we report an unusual case of AS with AMI in a young patient.
CASE SUMMARY A 37-year-old man was admitted to the Department of Rheumatology and Immunology of our hospital on March 14, 2020, for low back pain. Further evaluation with clinical examinations, laboratory tests, and imaging resulted in a diagnosis of AS. Treatment with a non-steroidal anti-inflammatory drug and a tumor necrosis factor inhibitor partially improved his symptoms. However, his back pain persisted. After 6 wk of treatment, he was admitted to the emergency room of another hospital in this city for sudden-onset severe chest pain consistent with a diagnosis of AMI. Angiography revealed severe narrowing of the coronary arteries. Surgical placement of two coronary stents completely relieved his back pain.
CONCLUSION AS can cause cardiovascular diseases, including AMI. It is important to consider the cardiovascular risks in the management of AS.
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Affiliation(s)
- Zhi-Hong Wan
- Department of Rheumatology and Immunology, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
| | - Jing Wang
- Department of Rheumatology and Immunology, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
| | - Qing Zhao
- Department of Rheumatology and Immunology, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
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Ferraz-Amaro I, Rueda-Gotor J, Genre F, Corrales A, Blanco R, Portilla V, González Mazón I, Llorca J, Expósito R, Vicente EF, Quevedo-Abeledo JC, Rodríguez-Lozano C, Ortega-Castro R, Ladehesa-Pineda ML, Fernández-Carballido C, Martínez-Vidal MP, Castro-Corredor D, Anino-Fernández J, García Vivar ML, Galíndez-Agirregoikoa E, Peiteado D, Plasencia-Rodríguez C, Montes Perez E, Fernández Díaz C, Castañeda S, González-Gay MÁ. Potential relation of cardiovascular risk factors to disease activity in patients with axial spondyloarthritis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211033755. [PMID: 34377161 PMCID: PMC8323406 DOI: 10.1177/1759720x211033755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/18/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Axial spondyloarthritis (axSpA) patients are known to have a higher
prevalence of several comorbidities, including, among others, an increased
risk of atherosclerosis, hypertension, dyslipidemia, and diabetes. The
purpose of the present study was to determine whether the sum of traditional
cardiovascular (CV) risk factors is related to disease characteristics, such
as disease activity, in patients with axSpA. Methods: A cross-sectional study that encompassed 804 patients with axSpA was
conducted. Patients were assessed for the presence of five traditional CV
risk factors (diabetes mellitus, dyslipidemia, hypertension, obesity, and
smoking status), and disease activity measurements. A multivariable
regression analysis was performed to evaluate whether the number of classic
CV risk factors was independently associated with specific features of the
disease, to include disease activity. Results: A multivariable analysis showed that Ankylosing Spondylitis Disease Activity
Score–C reactive protein (ASDAS-CRP) activity score was significantly higher
in patients with 1 [beta coefficient 0.3 (95% confidence interval (CI)
0.1–0.5), p = 0.001] and ⩾2 [beta coefficient 0.5 (95% CI
0.3–0.7), p = 0.000] CV risk factors compared with those
without CV risk factors. Similarly, patients with 1 [OR 2.00 (95%CI
0.99–4.02), p = 0.053] and ⩾2 [OR 3.39 (95%CI 1.82–6.31),
p = 0.000] CV risk factors had a higher odds ratio for
the presence of high disease activity compared with the zero CV category.
The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) activity
score was significantly associated with the number of CV risk factors, being
higher in patients with more CV risk factors. These relationships showed a
CV risk factor-dependent effect being beta coefficients and ORs higher for
the effect of ⩾2 over 1 CV risk factor. Conclusion: Among patients with axSpA, as the number of traditional CV risk factors
increased, disease activity similarly increases in an independent
manner.
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Affiliation(s)
| | | | - Fernanda Genre
- Epidemiology, Genetics and Atherosclerosis
Research Group on Systemic Inflammatory Diseases, IDIVAL, Santander,
Spain
| | - Alfonso Corrales
- Rheumatology Division, Hospital Universitario
Marqués de Valdecilla, Santander, Spain
| | - Ricardo Blanco
- Rheumatology Division, Hospital Universitario
Marqués de Valdecilla, Santander, Spain
| | - Virginia Portilla
- Rheumatology Division, Hospital Universitario
Marqués de Valdecilla, Santander, Spain
| | - Iñigo González Mazón
- Rheumatology Division, Hospital Universitario
Marqués de Valdecilla, Santander, Spain
| | - Javier Llorca
- Department of Epidemiology and Computational
Biology, School of Medicine, University of Cantabria, and CIBER
Epidemiología y Salud Pública (CIBERESP), Santander, Spain
| | - Rosa Expósito
- Rheumatology Division, Hospital Comarcal,
Laredo, Cantabria, Spain
| | - Esther F. Vicente
- Rheumatology Division, Hospital Universitario
de La Princesa, IIS-Princesa, Madrid, Spain
| | | | - Carlos Rodríguez-Lozano
- Rheumatology Division, Hospital Universitario
de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | | | - M Paz Martínez-Vidal
- Rheumatology Division, Hospital General
Universitario de Alicante, Alicante, Spain
| | - David Castro-Corredor
- Rheumatology Division, Hospital General
Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | | | | | | | | | - Santos Castañeda
- Rheumatology Division, Hospital Universitario
de La Princesa, IIS-Princesa, Madrid, Spain
| | - Miguel Ángel González-Gay
- Rheumatology Division and Epidemiology,
Genetics and Atherosclerosis Research Group on Systemic Inflammatory
Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander,
Spain
- School of Medicine, University of Cantabria,
Santander, Spain
- University of the Witwatersrand,
Cardiovascular Pathophysiology and Genomics Research Unit, School of
Physiology, Faculty of Health Sciences, South Africa
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14
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Michelena X, Zhao SS, Dubash S, Dean LE, Jones GT, Marzo-Ortega H. Similar biologic drug response regardless of radiographic status in axial spondyloarthritis: data from the BSRBR-AS registry. Rheumatology (Oxford) 2021; 60:5795-5800. [PMID: 33502476 PMCID: PMC8645273 DOI: 10.1093/rheumatology/keab070] [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: 10/29/2020] [Accepted: 01/05/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To describe the baseline characteristics, bDMARD response and drug survival of axSpA patients in the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis (BSRBR-AS) according to radiographic status. METHODS BSRBR-AS is a national prospective cohort including axSpA participants classified according to the ASAS criteria. In this analysis, baseline data of patients starting bDMARDs were compared. Ankylosing Spondylitis Disease Activity Scores (ASDAS) for low disease status, clinically important improvement (CII) and major improvement (MI) at one year were used to assess treatment response. Cox proportional hazard analysis was performed after adjusting for clinically relevant cofounders. RESULTS 1,145 axSpA patients were included. Higher male prevalence, older age and longer disease duration was seen in the r-axSpA subgroup. Based on a complete case analysis (290 patients), two thirds of patients achieved ASDAS low disease state at one year regardless of radiographic status (nr-axSpA: 64.2% vs r-axSpA: 66.1). No statistically significant differences were seen between the subgroups in attaining ASDAS CII (nr-axSpA: 50.7% vs r-axSpA: 44.7%) or MI (nr-axSpA: 20% vs r-axSpA: 18.7%). Drug survival probability curves were similar for both subgroups and hazard ratio for nr-axSpA/axSpA was 0.94 (95% CI 0.69-1.28) when adjusted for sex, age, baseline ASDAS-CRP, smoking status, disease duration, HLA-B27 and prescribed biologic. CONCLUSIONS Although there appeared to be some differences in the baseline characteristics when exploring this cohort according to radiographic status which are likely related to the natural history of the disease, the level of biologic response and drug survival was comparable between nr-axSpA and r-axSpA.
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Affiliation(s)
- Xabier Michelena
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Sizheng Steven Zhao
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Sayam Dubash
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Linda E Dean
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Gareth T Jones
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
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15
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Ahmed S, Gasparyan AY, Zimba O. Comorbidities in rheumatic diseases need special consideration during the COVID-19 pandemic. Rheumatol Int 2021; 41:243-256. [PMID: 33388969 PMCID: PMC7778868 DOI: 10.1007/s00296-020-04764-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/26/2020] [Indexed: 02/08/2023]
Abstract
Comorbidities in rheumatic and musculoskeletal diseases (RMDs) not only increase morbidity and mortality but also confound disease activity, limit drug usage and increase chances of severe infections or drug-associated adverse effects. Most RMDs lead to accelerated atherosclerosis and variable manifestations of the metabolic syndrome. Literature on COVID-19 in patients with RMDs, and the effects of various comorbidities on COVID-19 was reviewed. The initial data of COVID-19 infections in RMDs have not shown an increased risk for severe disease or the use of different immunosuppression. However, there are some emerging data that patients with RMDs and comorbidities may fare worse. Various meta-analyses have reiterated that pre-existing hypertension, cardiovascular disease, stroke, diabetes, chronic kidney disease, heart failure, lung disease or obesity predispose to increased COVID-19 mortality. All these comorbidities are commonly encountered in the various RMDs. Presence of comorbidities in RMDs pose a greater risk than the RMDs themselves. A risk score based on comorbidities in RMDs should be developed to predict severe COVID-19 and death. Additionally, there should be active management of such comorbidities to mitigate these risks. The pandemic must draw our attention towards, and not away from, comorbidities.
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Affiliation(s)
- Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, 751024, India.
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, West Midlands, UK
| | - Olena Zimba
- Department of Internal Medicine No. 2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
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16
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Liew JW, Ward MM, Reveille JD, Weisman M, Brown MA, Lee M, Rahbar M, Heckbert SR, Gensler LS. Nonsteroidal Antiinflammatory Drug Use and Association With Incident Hypertension in Ankylosing Spondylitis. Arthritis Care Res (Hoboken) 2020; 72:1645-1652. [PMID: 31529687 PMCID: PMC7075727 DOI: 10.1002/acr.24070] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 09/10/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Nonsteroidal antiinflammatory drugs (NSAIDs) increase blood pressure and potentially cardiovascular burden, which may limit their use in ankylosing spondylitis (AS). Our objective was to determine the association of NSAID use with incident hypertension in a longitudinal AS cohort. METHODS Adults with AS were enrolled in a prospective cohort study of patient outcomes and examined every 4-6 months. Hypertension was defined by patient-reported hypertension; antihypertensive medication use; or, on 2 consecutive visits, systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Continuous NSAID use was dichotomized based on the validated NSAID index. We assessed the association of NSAID use as a time-varying exposure with the incidence of hypertension using Cox proportional hazards models. RESULTS Of the 1,282 patients in the cohort, 628 patients without baseline hypertension had at least 1 year of follow-up and were included in the analysis. Of these, 72% were male, the mean age at baseline was 39 ± 13 years, and 200 patients used NSAIDs continuously. On follow-up, 129 developed incident hypertension. After controlling for other variables, continuous NSAID use was associated with a hazard ratio of 1.12 for incident hypertension (95% confidence interval 1.04-1.20), compared to noncontinuous or no use. The association did not differ in subgroups defined by age, body mass index, biologic use, or disease activity. CONCLUSION In our prospective, longitudinal AS cohort, continuous NSAID use was associated with a 12% increased risk for the development of incident hypertension, as compared to noncontinuous or no NSAID use.
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Affiliation(s)
| | - Michael M Ward
- National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH, Bethesda, Maryland
| | - John D Reveille
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston
| | - Michael Weisman
- Cedars-Sinai Medical Center and David Geffen School of Medicine, University of California at Los Angeles
| | - Matthew A Brown
- Queensland University of Technology and Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - MinJae Lee
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston
| | - Mohammed Rahbar
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston
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17
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Keat A, Bennett AN, Gaffney K, Jones GT, Martindale J, Sengupta R, Siebert S, Marzo-Ortega H. BRITSpA at five. Rheumatology (Oxford) 2020; 59:699-701. [PMID: 31710687 DOI: 10.1093/rheumatology/kez523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/19/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Alexander N Bennett
- Defence Medical Rehabilitation Centre, Academic Department of Military Rehabilitation, Stanford Hall, Nottinghamshire
| | - Karl Gaffney
- Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich
| | - Gareth T Jones
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen
| | | | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Bath
| | - Stefan Siebert
- Institute for Infection, Immunity and Inflammation, University of Glasgow, Glasgow
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK
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18
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Atzeni F, Nucera V, Galloway J, Zoltán S, Nurmohamed M. Cardiovascular risk in ankylosing spondylitis and the effect of anti-TNF drugs: a narrative review. Expert Opin Biol Ther 2019; 20:517-524. [PMID: 31847607 DOI: 10.1080/14712598.2020.1704727] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Cardiovascular (CV) mortality is increased in patients with ankylosing spondylitis (AS), but little is known about CV morbidity beyond the fact that they have a two-fold higher prevalence of ischemic heart disease than controls due to the inflammatory pattern of the disease itself, and a higher prevalence of traditional CV risk factors than the general population. Anti-TNF drugs reduce inflammation and a number of studies have reported a reduction in sub-clinical atherosclerosis in AS patients treated with anti-TNF drugs, thus suggesting that inflammation contributes to their higher CV risk. Anti-TNF drugs also alter the lipid profiles of AS patients, although these changes may reflect their normalization secondary to inflammation control, and improve their other myocardial alterations.Areas covered: This review concentrates on the risk of cardiovascular morbidity and mortality among AS patients and the effect of anti-TNF drugs on this risk, with particular emphasis on the putative causes involved and the aspects that are relevant in clinical practice.Expert opinion: The growing evidence of CV disease in AS means that all clinicians need to know how to prevent it and treat patients appropriately. It is important to bear in mind the EULAR guidelines, which state that a rheumatologist is responsible for monitoring all AS patients for signs of CV involvement because this is essential in order to ensure that they are treated properly. As there is little clinical evidence concerning the effects of biological drugs other than anti-TNF agents, treatment should be decided on the basis of the clinical aspects of the type of AS and the CV co-morbidity: for example, patients who are hypertensive or dyslipidemic should immediately start treatment with an anti-hypertensive agent and/or a statin. All of the patients should be educated to prevent CV events by keeping to a balanced healthy diet, avoiding tobacco smoking, and maintaining normal blood pressure, LDL-cholesterol and glucose levels. Finally, all clinicians (but particularly rheumatologists) should always bear in mind CV complications in order to guarantee that the quality of life of AS patients is as good as possible.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, University of Messina, Messina, Italy
| | - Valeria Nucera
- Rheumatology Unit, University of Messina, Messina, Italy
| | - James Galloway
- Centre for Rheumatic Disease, Kings College London, London, UK
| | - Szekanecz Zoltán
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Mike Nurmohamed
- Department of Rheumatology Reade, Amsterdam Rheumatology and Immunology Center, Reade & VU University Medical Center, Amsterdam, The Netherlands
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19
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Derakhshan MH, Goodson NJ, Packham J, Sengupta R, Molto A, Marzo-Ortega H, Siebert S. Association of Diverticulitis with Prolonged Spondyloarthritis: An Analysis of the ASAS-COMOSPA International Cohort. J Clin Med 2019; 8:jcm8030281. [PMID: 30813544 PMCID: PMC6462988 DOI: 10.3390/jcm8030281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/12/2019] [Accepted: 02/21/2019] [Indexed: 01/18/2023] Open
Abstract
This study examined the relationship between spondyloarthritis (SpA) duration and gastrointestinal comorbidities other than inflammatory bowel disease (IBD). We evaluated the association between SpA duration and upper gastrointestinal ulcers, hepatitis B (HBV), hepatitis C (HCV) and diverticulitis using data from a large international cross-sectional study. Binary regression models were created, adjusted for age, sex, body mass index (BMI), smoking, alcohol, non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), biologics, steroids, IBD history and country. Subgroup analysis was performed by disease phenotype. The data of 3923 participants were analysed. The prevalence of gastrointestinal conditions were 10.7% upper gastrointestinal ulcers; 4.7% viral hepatitis and 1.5% diverticulitis. While SpA duration was not associated with upper gastrointestinal ulcers, HBV or HCV, longer SpA duration was significantly associated with diverticulitis (odds ratios (OR) = 1.18, 95% confidence interval (CI): 1.03⁻1.34), reflecting an 18% increase for every five years of SpA duration. Other significant associations with diverticulitis were age and high alcohol intake but not medication history. In subgroup analyses, the association was strongest with those with axial SpA. The reasons for this association of increased diverticulitis with disease duration in SpA, especially those with axial disease, are unclear but may reflect shared underlying gut inflammation. Diverticulitis should be considered, in addition to IBD, when SpA patients present with lower gastrointestinal symptoms.
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Affiliation(s)
- Mohammad H Derakhshan
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G61 1QH, UK.
| | - Nicola J Goodson
- Academic Rheumatology Department, University of Liverpool, Liverpool L69 3GJ, UK.
| | | | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Bath BA1 1RL, UK.
| | - Anna Molto
- Paris Descartes University, Hôpital Cochin, 75005 Paris, France.
| | - Helena Marzo-Ortega
- NIHR LBRC, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds, Leeds LS2 9JT, UK.
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G61 1QH, UK.
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