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Ben Tekaya A, Boukriba S, Fendri A, Rouached L, Saidane O, Bouden S, Tekaya R, Ben Salem K, Mahmoud I, Habiba M, Abdelmoula L. Endothelial dysfunction and increased carotid intima-media thickness in patients with spondyloarthritis without traditional cardiovascular risk factors. RMD Open 2022; 8:rmdopen-2022-002270. [PMID: 35793876 PMCID: PMC9260841 DOI: 10.1136/rmdopen-2022-002270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/07/2022] [Indexed: 12/13/2022] Open
Abstract
Background The aim of our study was to assess subclinical atherosclerosis in spondyloarthritis (SpA) by combining three ultrasound methods (flow-mediated dilation (FMD), carotid intima–media thickness (cIMT) and Ankle Brachial Index (ABI)) and to determine the predictive factors of theses parameters. Methods This was a case control study conducted over 12 months including 47 patients with SpA-free-cardiovascular (CV) disease in comparison with age and sex matched 47 healthy controls. Sociodemographic, clinical and biological features as well as therapeutic modalities were recorded in our patients. All subjects had Doppler ultrasound with measurement of cIMT, FMD and ABI. Ultrasound measurements were compared between patients and controls. Linear regression was performed and assessed by machine learning to determine the predictive models of markers of subclinical atherosclerosis. Results We found higher cIMT (p<0.0001), lower FMD (p=0.008) and higher left ABI (0.048) in patients with SpA compared with controls. cIMT was positively correlated to patient-related parameters (age, systolic blood pressure) and disease parameters (age at onset of SpA, disease duration and renal involvement). Biologically, cIMT was positively correlated with creatinine, blood-glocose, total cholesterol (CT) and CT/cholesterol-high density lipoprotein ratio. FMD was negatively correlated with male gender, age, systolic blood pressure, creatinine, blood glucose and Left Lequesne Index. ABI was significantly associated with diastolic blood pressure. Multiple regression analysis identified age, CT and creatinine as independents predictive factors for increased cIMT. Regarding endothelial dysfunction, blood glucose and Left Lequesne Index were the independents predictive factors of decreased FMD. Conclusion Our study supported the accelerated subclinical atherosclerosis in patients with SpA. This subclinical atherosclerosis was mainly mediated by traditional CV risk factors.
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Affiliation(s)
- Aicha Ben Tekaya
- Rheumatology Department Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Seif Boukriba
- Radiology Department, La Rabta Hospital, Faculty of medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Ahmed Fendri
- Radiology Department, La Rabta Hospital, Faculty of medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Leila Rouached
- Rheumatology Department Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Olfa Saidane
- Rheumatology Department Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Selma Bouden
- Rheumatology Department Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Rawdha Tekaya
- Rheumatology Department Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | | | - Ines Mahmoud
- Rheumatology Department Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Mizouni Habiba
- Radiology Department, La Rabta Hospital, Faculty of medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Leila Abdelmoula
- Rheumatology Department Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
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Falsetti P, Conticini E, Mazzei MA, Baldi C, Sota J, Bardelli M, Gentileschi S, D'Alessandro R, Al Khayyat SG, Acciai C, Cantarini L, Frediani B. Power and spectral Doppler ultrasound in suspected active sacroiliitis: a comparison with magnetic resonance imaging as gold standard. Rheumatology (Oxford) 2021; 60:1338-1345. [PMID: 32944757 DOI: 10.1093/rheumatology/keaa546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/21/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The objectives of this study were to study with Power Doppler US (PDUS) the SI joints (SIJs) of patients with suspected active sacroiliitis, to describe SIJ flows with spectral wave analysis (SWA) on Doppler US, and to correlate US data with both clinical characteristics and presence of SIJ bone marrow oedema (BME) in subsequent MRI. METHODS A total of 42 patients (32 females and 10 males, mean age 46.8 years) with recent onset of inflammatory back pain (IBP) were included. Every patient underwent US examination with a convex 1-8 MHz probe [scoring PDUS signals with a three-point scale and describing flows in SWA calculating the mean Resistive Index (RI)] and subsequent MRI of the SIJs. RESULTS PDUS signals were detected in 34 patients and 62 SIJs. In 29 patients and 56 SIJs, MRI revealed BME. A definite diagnosis of SpA was made in 32 patients. PDUS signals were more frequent (P < 0.0001) in patients with a final diagnosis of SpA, yielding a higher PDUS score (P = 0.0304). PDUS grading correlated with both BME grading (r = 0.740, P = 0.0001) and AS DAS (ASDAS) (r = 0.6257, P = 0.0004), but not with inflammatory reactants nor anthropometric data. Mean RI were, respectively, 0.60 and 0.73 (P < 0.0001) in patients with or without diagnosis of active sacroiliitis. The most inclusive RI cut-off resulted <0.70 [positive predictive value (PPV) 94%, accuracy 90%, P = 0.0001]. The best Likelihood Ratio (5.471) for RI to detect pathologic cases was obtained with a cut-off of <0.60 (PPV 96%). CONCLUSIONS PDUS and SWA of SIJs demonstrate good diagnostic accuracy for active sacroiliitis compared with MRI.
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Affiliation(s)
- Paolo Falsetti
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Edoardo Conticini
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Maria Antonietta Mazzei
- Department of Medical, Surgical and Neurosciences, Diagnostic Imaging, University of Siena, Arezzo, Italy
| | - Caterina Baldi
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Jurgen Sota
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Marco Bardelli
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Stefano Gentileschi
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Roberto D'Alessandro
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | | | | | - Luca Cantarini
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Bruno Frediani
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
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Mendonça JA, Pansani LN, Mimoto MB, Ferreira ITG, Sanches FB, de Campos Ferreira Pinto T, Leandro-Merhi VA, de Aquino JLB. Nail enthesis ultrasound and automated software-guided assessment of bilateral common carotid intima-media thickness in psoriasis and psoriatic arthritis: is there a correlation with clinical and laboratory findings? Drugs Context 2020; 9:2020-1-2. [PMID: 32547626 PMCID: PMC7271708 DOI: 10.7573/dic.2020-1-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Ultrasound (US) in psoriasis (PsO) and psoriatic arthritis (PsA) is an important tool in several situations to detect joint ecostructural damage as well as other tissue alterations, such as those that occur in the larger vessels. The objective of this study was to detect and correlate the changes that indicate the inflammatory and atherosclerotic process in two groups of patients, using nail US and carotid artery intima-media thickness radiofrequency (RF) software. METHODS A total of 30 patients diagnosed with (PsO) and (PsA) were selected. About 15 patients were present in each group, assigned by the Dermatology and Rheumatology Service of the Universidade Pontifícia Católica de Campinas, São Paulo, Brazil, and were assessed using carotid artery US (radiofrequency quality intima-media thickness [RF-QIMT]), joint US, clinical evaluation, and laboratory tests. RESULTS Spearman and Pearson correlations between US variables per group were Psoriasis Area and Severity Index (PASI) and loss of the nail pattern trilaminar: r=0.658, p=0.015; Framingham Score (FS) and Internal Resistance Index (IR): 0.351 to 0.526, p=0.034 to 0.002; the significant correlations by the Bayesian factor (BF) were those with a BF greater than 2.5, between QIMT expected with FS: r=0.677, BF=10.06, with total cholesterol: r=0.5232, BF=2.60, and QIMT-RF with low density lipoproteins: r=0.633, BF=3.70. CONCLUSION The use of US in the evaluation of these patients showed significant correlations between clinical and laboratory measures, characterized by QIMT and FS as well as changes in nail insertion. Future studies may demonstrate an even better interaction.
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Affiliation(s)
- José Alexandre Mendonça
- Serviço de Reumatologia, Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
- Health Sciences Post-Graduation Program, PUC-Campinas – SP-Brazil Research Group: Diagnostics and Clinical and Surgical Therapy, São Paulo, Brazil
| | - Lucas Nogueira Pansani
- Serviço de Reumatologia, Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
| | - Mateus Basso Mimoto
- Serviço de Reumatologia, Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
| | | | | | | | - Vania Aparecida Leandro-Merhi
- Health Sciences Post-Graduation Program, PUC-Campinas – SP-Brazil Research Group: Diagnostics and Clinical and Surgical Therapy, São Paulo, Brazil
| | - José Luis Braga de Aquino
- Health Sciences Post-Graduation Program, PUC-Campinas – SP-Brazil Research Group: Diagnostics and Clinical and Surgical Therapy, São Paulo, Brazil
- Serviço de Clínica Cirúrgica e Pós Graduação da Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
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Abrahão-Machado ECF, Mendonça JA, Arruda ACBB, Nucci LB, Santos MASD. Analysis of cardiovascular risk and carotid intima-media thickness in patients with psoriasis. An Bras Dermatol 2020; 95:150-157. [PMID: 32122693 PMCID: PMC7175101 DOI: 10.1016/j.abd.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/11/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Psoriasis is associated with atherosclerosis and increased cardiovascular risk. Currently, an automated ultrasound, called quantitative intima media thickness, has proven to be a useful method to evaluate subclinical atherosclerosis. OBJECTIVES To compare increased cardiovascular risk in psoriasis patients receiving two types of treatments: Methotrexate and tumor necrosis factor inhibitor and to evaluate the correlation between the Framingham score and quantitative intima media thickness. METHODS Fifty patients with plaque psoriasis were selected from June 2017 to July 2018, divided into two groups, receiving methotrexate and tumor necrosis factor inhibitor. Measurement of abdominal circumference, blood pressure, body mass index and presence of metabolic syndrome were performed. Afterwards, the patients were evaluated for increased cardiovascular risk with the Framingham score and for the quantitative intima media thickness of the carotid arteries. RESULTS The mean age was 54.8 (±12.5) with a slight male predominance (58%). Overall, 84% of the patients had elevated waist circumference, 82% had a body mass index above ideal, and 50% had a metabolic syndrome. For the correlation between quantitative intima media thickness and Framingham Score, Pearson's linear correlation coefficient was 0.617 (p<0.001), indicating a moderate to strong positive association. STUDY LIMITATIONS The protective effect of the therapies cited in relation to the increased cardiovascular risk was not evaluated. CONCLUSIONS A moderate to strong positive association was found correlating the Framingham Score values with the quantitative intima media thickness measurement and it is not possible to state which drug has the highest increased cardiovascular risk.
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Affiliation(s)
| | - José Alexandre Mendonça
- Rheumatology Outpatient Clinic, Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil
| | | | - Luciana Bertoldi Nucci
- Postgraduate Program, Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil
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Everson F, De Boever P, Nawrot TS, Goswami N, Mthethwa M, Webster I, Martens DS, Mashele N, Charania S, Kamau F, Strijdom H. Personal NO 2 and Volatile Organic Compounds Exposure Levels are Associated with Markers of Cardiovascular Risk in Women in the Cape Town Region of South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2284. [PMID: 31261612 PMCID: PMC6651077 DOI: 10.3390/ijerph16132284] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 06/09/2019] [Accepted: 06/15/2019] [Indexed: 12/24/2022]
Abstract
Exposure to ambient NO2 and benzene, toluene ethyl-benzene and m+p- and o-xylenes (BTEX) is associated with adverse cardiovascular effects, but limited information is available on the effects of personal exposure to these compounds in South African populations. This 6-month follow-up study aims to determine 7-day personal ambient NO2 and BTEX exposure levels via compact passive diffusion samplers in female participants from Cape Town, and investigate whether exposure levels are associated with cardiovascular risk markers. Overall, the measured air pollutant exposure levels were lower compared to international standards. NO2 was positively associated with systolic and diastolic blood pressure (SBP and DBP), and inversely associated with the central retinal venular equivalent (CRVE) and mean baseline brachial artery diameter. o-xylene was associated with DBP and benzene was strongly associated with carotid intima media thickness (cIMT). Our findings showed that personal air pollution exposure, even at relatively low levels, was associated with several markers of cardiovascular risk in women residing in the Cape Town region.
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Affiliation(s)
- Frans Everson
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| | - Patrick De Boever
- Health Unit, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium.
- Centre for Environmental Sciences, Hasselt University, 3590 Diepenbeek, Belgium.
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Nandu Goswami
- Division of Physiology, Otto Loewi Research Center of Vascular Biology, Immunity and Inflammation, Medical University of Graz, 8036 Graz, Austria
| | - Mashudu Mthethwa
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| | - Ingrid Webster
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| | - Dries S Martens
- Centre for Environmental Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Nyiko Mashele
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| | - Sana Charania
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| | - Festus Kamau
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| | - Hans Strijdom
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
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