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Rojas-Giménez M, López-Medina C, Calvo-Gutiérrez J, Puche-Larrubia MÁ, Gómez-García I, Seguí-Azpilcueta P, Ábalos-Aguilera MDC, Ruíz D, Collantes-Estévez E, Escudero-Contreras A. Association between Carotid Intima-Media Thickness and the Use of Biological or Small Molecule Therapies in Patients with Rheumatoid Arthritis. Diagnostics (Basel) 2021; 12:diagnostics12010064. [PMID: 35054229 PMCID: PMC8775122 DOI: 10.3390/diagnostics12010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: The objective of this study was to assess the association of carotid intima-media thickness (CIMT), and also the presence of atheromatous plaque, with biological and targeted synthetic disease-modifying antirheumatic drugs, in an established cohort of patients with rheumatoid arthritis (RA). Patients and Methods: We conducted a cross-sectional observational study based on a cohort of patients with RA and a registry of healthy controls, in whom the CIMT and presence of atheromatous plaque were assessed by ultrasound. Data were collected on disease activity, lab results and treatments. Descriptive and bivariate analyses were performed and two multivariate linear regression models (with CIMT as the dependent variable) were constructed to identify variables independently associated with CIMT in our sample of patients with RA. Results: A total of 176 individuals (146 patients with RA and 30 controls) were included. A higher percentage of patients than controls had atheromatous plaque (33.8% vs. 12.5%, p = 0.036), but no differences were found in terms of CIMT (0.64 vs. 0.61, p = 0.444). Compared to values in patients on other therapies, the CIMT was smaller among patients on tumour necrosis factor alpha (TNFα) inhibitors (mean [SD]: 0.58 [0.10] vs. 0.65 [0.19]; p = 0.013) and among those on Janus kinase inhibitors (mean [SD]: 0.52 [0.02] vs. 0.64 [0.18]; p < 0.001), while no differences were found as a function of the use of the other therapies considered. The multivariate linear regression analysis to identify factors associated with CIMT in our patients, adjusting for traditional cardiovascular risk factors such as hypertension, high levels of low-density lipoproteins, diabetes mellitus and smoking, showed that male sex, older age and having a greater cumulative erythrocyte sedimentation rate were independently associated with a larger CIMT, while patients on TNFα inhibitors had a CIMT 0.075 mm smaller than those on other treatments. Conclusions: The use of TNFα inhibitors may protect against subclinical atherosclerosis in patients with RA, patients on this biologic having smaller CIMTs than patients on other disease-modifying antirheumatic drugs. Nonetheless, these results should be confirmed in prospective studies with larger sample sizes.
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Affiliation(s)
- Marta Rojas-Giménez
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
| | - Clementina López-Medina
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
- Correspondence:
| | - Jerusalem Calvo-Gutiérrez
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
| | - María Ángeles Puche-Larrubia
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
| | - Ignacio Gómez-García
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
| | - Pedro Seguí-Azpilcueta
- Reina Sofia University Hospital, Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain; (P.S.-A.); (M.d.C.Á.-A.); (E.C.-E.); (A.E.-C.)
| | - María del Carmen Ábalos-Aguilera
- Reina Sofia University Hospital, Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain; (P.S.-A.); (M.d.C.Á.-A.); (E.C.-E.); (A.E.-C.)
| | - Desirée Ruíz
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
| | - Eduardo Collantes-Estévez
- Reina Sofia University Hospital, Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain; (P.S.-A.); (M.d.C.Á.-A.); (E.C.-E.); (A.E.-C.)
| | - Alejandro Escudero-Contreras
- Reina Sofia University Hospital, Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain; (P.S.-A.); (M.d.C.Á.-A.); (E.C.-E.); (A.E.-C.)
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Bautista-Aguilar L, López-Medina C, Ladehesa-Pineda L, Ábalos-Aguilera MDC, Ruiz-Vilchez D, Garrido-Castro JL, Gómez-García I, Puche-Larrubia MÁ, Salmoral-Chamizo A, Collantes-Estévez E, Escudero-Contreras A, Font-Ugalde P. Prevalence and Associated Factors of Low Bone Mineral Density in the Femoral Neck and Total Hip in Axial Spondyloarthritis: Data from the CASTRO Cohort. J Clin Med 2021; 10:jcm10122664. [PMID: 34204210 PMCID: PMC8235737 DOI: 10.3390/jcm10122664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/05/2021] [Accepted: 06/14/2021] [Indexed: 12/03/2022] Open
Abstract
Studies on osteoporosis in axial spondyloarthritis (axSpA) have focused on the lumbar segment, and few studies have assessed bone mineral density (BMD) in the hip and femoral neck in these patients. The aim of this study was to evaluate the prevalence of low BMD and osteopenia in the total hip or femoral neck and the factors associated with these conditions in axSpA patients. This was a single-centre, observational, cross-sectional study among consecutive patients with axSpA according to the ASAS criteria from the CASTRO registry. All patients underwent total hip and femoral neck DXA BMD measurements. Low BMD was defined as a Z-score less than −1, and osteopenia was defined as a T-score less than −1. Multivariate logistic and generalised linear regressions were used to evaluate factors independently associated with low BMD and osteopenia in the hip or femoral neck and those associated with variability in BMD, respectively. A total of 117 patients were included, among which 30.8% were female and the mean age was 45 years. A total of 36.0% of patients had low BMD (28.1% in the total hip and 27.4% in the femoral neck), and 56.0% of patients had osteopenia (44.7% in the total hip and 53.8% in the femoral neck). A multivariate logistic regression showed that age, radiographic sacroiliitis and ASAS-HI were independently associated with low BMD in the total hip or femoral neck. Factors that were independently associated with osteopenia were Body Mass Index, disease duration, radiographic sacroiliitis and ASAS-HI. In conclusion, 36% of the patients with axSpA had low BMD in the total hip or femoral neck. A younger age and radiographic sacroiliitis were the most important factors associated with decreased BMD.
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Affiliation(s)
- Laura Bautista-Aguilar
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (L.B.-A.); (L.L.-P.); (M.d.C.Á.-A.); (D.R.-V.); (I.G.-G.); (M.Á.P.-L.); (A.S.-C.); (E.C.-E.); (A.E.-C.); (P.F.-U.)
- GC05 Group, Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain
- Medical and Surgical Sciences Department, University of Cordoba, 14004 Cordoba, Spain;
| | - Clementina López-Medina
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (L.B.-A.); (L.L.-P.); (M.d.C.Á.-A.); (D.R.-V.); (I.G.-G.); (M.Á.P.-L.); (A.S.-C.); (E.C.-E.); (A.E.-C.); (P.F.-U.)
- GC05 Group, Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain
- Medical and Surgical Sciences Department, University of Cordoba, 14004 Cordoba, Spain;
- Correspondence:
| | - Lourdes Ladehesa-Pineda
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (L.B.-A.); (L.L.-P.); (M.d.C.Á.-A.); (D.R.-V.); (I.G.-G.); (M.Á.P.-L.); (A.S.-C.); (E.C.-E.); (A.E.-C.); (P.F.-U.)
- GC05 Group, Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain
- Medical and Surgical Sciences Department, University of Cordoba, 14004 Cordoba, Spain;
| | - María del Carmen Ábalos-Aguilera
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (L.B.-A.); (L.L.-P.); (M.d.C.Á.-A.); (D.R.-V.); (I.G.-G.); (M.Á.P.-L.); (A.S.-C.); (E.C.-E.); (A.E.-C.); (P.F.-U.)
- GC05 Group, Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain
- Medical and Surgical Sciences Department, University of Cordoba, 14004 Cordoba, Spain;
| | - Desirée Ruiz-Vilchez
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (L.B.-A.); (L.L.-P.); (M.d.C.Á.-A.); (D.R.-V.); (I.G.-G.); (M.Á.P.-L.); (A.S.-C.); (E.C.-E.); (A.E.-C.); (P.F.-U.)
- GC05 Group, Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain
- Medical and Surgical Sciences Department, University of Cordoba, 14004 Cordoba, Spain;
| | | | - Ignacio Gómez-García
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (L.B.-A.); (L.L.-P.); (M.d.C.Á.-A.); (D.R.-V.); (I.G.-G.); (M.Á.P.-L.); (A.S.-C.); (E.C.-E.); (A.E.-C.); (P.F.-U.)
- GC05 Group, Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain
- Medical and Surgical Sciences Department, University of Cordoba, 14004 Cordoba, Spain;
| | - María Ángeles Puche-Larrubia
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (L.B.-A.); (L.L.-P.); (M.d.C.Á.-A.); (D.R.-V.); (I.G.-G.); (M.Á.P.-L.); (A.S.-C.); (E.C.-E.); (A.E.-C.); (P.F.-U.)
- GC05 Group, Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain
- Medical and Surgical Sciences Department, University of Cordoba, 14004 Cordoba, Spain;
| | - Asunción Salmoral-Chamizo
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (L.B.-A.); (L.L.-P.); (M.d.C.Á.-A.); (D.R.-V.); (I.G.-G.); (M.Á.P.-L.); (A.S.-C.); (E.C.-E.); (A.E.-C.); (P.F.-U.)
- GC05 Group, Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain
| | - Eduardo Collantes-Estévez
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (L.B.-A.); (L.L.-P.); (M.d.C.Á.-A.); (D.R.-V.); (I.G.-G.); (M.Á.P.-L.); (A.S.-C.); (E.C.-E.); (A.E.-C.); (P.F.-U.)
- GC05 Group, Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain
- Medical and Surgical Sciences Department, University of Cordoba, 14004 Cordoba, Spain;
| | - Alejandro Escudero-Contreras
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (L.B.-A.); (L.L.-P.); (M.d.C.Á.-A.); (D.R.-V.); (I.G.-G.); (M.Á.P.-L.); (A.S.-C.); (E.C.-E.); (A.E.-C.); (P.F.-U.)
- GC05 Group, Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain
- Medical and Surgical Sciences Department, University of Cordoba, 14004 Cordoba, Spain;
| | - Pilar Font-Ugalde
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (L.B.-A.); (L.L.-P.); (M.d.C.Á.-A.); (D.R.-V.); (I.G.-G.); (M.Á.P.-L.); (A.S.-C.); (E.C.-E.); (A.E.-C.); (P.F.-U.)
- GC05 Group, Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain
- Medical and Surgical Sciences Department, University of Cordoba, 14004 Cordoba, Spain;
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Aranda-Valera IC, Arias de la Rosa I, Roldán-Molina R, Ábalos-Aguilera MDC, Torres-Granados C, Patiño-Trives A, Luque-Tevar M, Ibáñez-Costa A, Guzmán-Ruiz R, Malagón MDM, Escudero-Contreras A, López-Pedrera C, Collantes-Estévez E, Barbarroja N. Subclinical cardiovascular risk signs in adults with juvenile idiopathic arthritis in sustained remission. Pediatr Rheumatol Online J 2020; 18:59. [PMID: 32665015 PMCID: PMC7362625 DOI: 10.1186/s12969-020-00448-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/03/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) is one of the most common chronic diseases of childhood that often persists into adulthood and can result in significant long-term morbidity. As a long lasting chronic inflammatory disease, concern has been raised regarding the risk of premature development of cardiovascular disease (CVD) in JIA. This study aims to determine whether adults with JIA in clinical remission display clinical and subclinical signs of CVD risk: inflammatory mediators, adipokines, endothelial dysfunction and oxidative stress markers. METHODS This is a cross-sectional study including 25 patients diagnosed with JIA according to the International League of Associations for Rheumatology criteria (ILAR 2001) and 25 age- and sex-matched controls. Remission was determined by JADAS10 < 1 and according to Wallace criteria. The presence of traditional CVD risk factors was analyzed. An extensive clinical analysis including body mass index (BMI), lipid profile, homeostatic model assessment - insulin resistance (HOMA-IR) and arterial blood pressure was performed. Intima media thickness of the common carotid artery (CIMT) was measured as a marker of subclinical atherosclerosis. Several proinflammatory cytokines, molecules involved in the endothelial dysfunction, oxidative stress and adipokines were quantified on serum by ELISA and on peripheral blood mononuclear cells (PBMCs) by RT-PCR. In vitro studies were carried out in healthy PBMCs, adipocytes and endothelial cells which were treated with serum from JIA patients under sustained remission. RESULTS Mean duration of the disease was 13.47 ± 5.47 years. Mean age was 25.11 ± 7.21. Time in remission was 3.52 ± 3.33 years. Patients were in remission with no treatment (40%) and with treatments (60%). CVD risk factors and CIMT were similar in JIA patients and controls. However, cholesterol levels were significantly elevated in JIA patients. Levels of adipocytokines, oxidative stress and endothelial activation markers were elevated in serum and PBMCs from JIA patients. Serum of those JIA patients induced the activation of adipocytes, endothelial cells and healthy PBMCs. CONCLUSIONS JIA adult patients in remission have subclinical signs of inflammation and CVD risk, showed by an increase in the levels of inflammatory cytokines, endothelial activation and oxidative stress markers and adipokines, molecules closely involved in the alteration of the vascular system.
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Affiliation(s)
| | - Iván Arias de la Rosa
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain ,grid.428865.50000 0004 0445 6160Medicine Department, University of Cordoba/IMIBIC/Reina Sofía University Hospital, Cordoba, Spain
| | - Rosa Roldán-Molina
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain
| | - María del Carmen Ábalos-Aguilera
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain
| | - Carmen Torres-Granados
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain
| | - Alejandra Patiño-Trives
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain
| | - María Luque-Tevar
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain
| | - Alejandro Ibáñez-Costa
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain
| | - Rocío Guzmán-Ruiz
- grid.411901.c0000 0001 2183 9102Department of Cell Biology, Physiology and Immunology, IMIBIC, Reina Sofía University Hospital, University of Córdoba, Cordoba, Spain
| | - María del Mar Malagón
- grid.411901.c0000 0001 2183 9102Department of Cell Biology, Physiology and Immunology, IMIBIC, Reina Sofía University Hospital, University of Córdoba, Cordoba, Spain ,grid.413448.e0000 0000 9314 1427CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Alejandro Escudero-Contreras
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain
| | - Chary López-Pedrera
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain
| | - Eduardo Collantes-Estévez
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain ,grid.428865.50000 0004 0445 6160Medicine Department, University of Cordoba/IMIBIC/Reina Sofía University Hospital, Cordoba, Spain
| | - Nuria Barbarroja
- Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain. .,Medicine Department, University of Cordoba/IMIBIC/Reina Sofía University Hospital, Cordoba, Spain. .,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
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