1
|
Law L, Lindqvist P, Liv P, Hellman U, Lejon K, Geijer M, Söderberg S, Forsblad-d'Elia H. Increased carotid intima-media thickness in patients with radiographic axial spondyloarthritis compared to controls and associations with markers of inflammation. Clin Rheumatol 2024; 43:1559-1570. [PMID: 38443604 PMCID: PMC11018678 DOI: 10.1007/s10067-024-06913-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE There is an increased risk for cardiovascular disease (CVD) in patients with radiographic axial spondyloarthritis (r-axSpA). In this cross-sectional study, we aimed to, overall and stratified by sex, (i) compare ultrasound derived carotid intima media thickness (cIMT), between patients and controls, and (ii) investigate associations between cIMT, clinical disease activity and inflammation-related laboratory markers in patients with r-axSpA. METHOD In total, 155 patients diagnosed with r-axSpA using the modified New York criteria and 400 controls were included. Bilateral carotid ultrasound, laboratory testing, and questionaries were acquired. Disease-specific assessments were carried out for patients. Linear regression analysis was used to assess associations. RESULTS Linear regression analyses showed that patients with r-axSpA had increased mean cIMT compared to controls (mean ± SD, 0.8 ± 0.1 mm vs 0.7± 0.1 mm, respectively, unstandardized β (95% CI) -0.076 (-0.10, -0.052), P < 0.001) adjusted for smoking status and age. Linear regression analyses for patients with r-axSpA showed that only males presented significant associations between cIMT and inflammation-related laboratory markers, white blood cell (WBC) count (mean ± SD, 6.8 ± 1.6 109/L) and monocytes (0.6 ± 0.2 109/L); WBC count (unstandardized β (95% CI) 0.019 (0.0065, 0.031), P = 0.003, R2 = 0.57) and monocytes (0.13 (0.0047, 0.26), P = 0.041, R2 = 0.55), adjusted for age, smoking status, body mass index, hypertension, dyslipidemia, diabetes mellitus, ASDAS-CRP, and treatment with DMARDs and glucocorticoids. No significant association was found between cIMT and clinical disease activity assessed by ASDAS-CRP. CONCLUSION Patients with r-axSpA had significantly increased cIMT compared to controls. In male patients, higher WBC and monocyte count were associated with an increase in cIMT suggesting the role of inflammation in the development of atherosclerosis. Key Points •Carotid intima-media thickness was increased in patients with radiographic axial spondyloarthritis compared to controls. •White blood cell and monocyte counts were associated with carotid intima-media thickness in male patients with radiographic axial spondyloarthritis.
Collapse
Affiliation(s)
- Lucy Law
- Department of Public Health and Clinical Medicine, Unit of Medicine, Umeå University, Umeå, Sweden.
| | - Per Lindqvist
- Department of Surgical and Perioperative Sciences, Clinical Physiology, Umeå University, Umeå, Sweden
| | - Per Liv
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Urban Hellman
- Department of Public Health and Clinical Medicine, Unit of Medicine, Umeå University, Umeå, Sweden
| | - Kristina Lejon
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Mats Geijer
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Unit of Medicine, Umeå University, Umeå, Sweden
| | - Helena Forsblad-d'Elia
- Department of Public Health and Clinical Medicine, Unit of Medicine, Umeå University, Umeå, Sweden
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinic of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
2
|
Dalecky M, Dujardin T, Pflimlin A, Baillet A, Romand X. Cardiac conduction disorders in ankylosing spondylitis: A systematic literature review and meta-analyses of controlled studies. Joint Bone Spine 2024; 91:105676. [PMID: 38104656 DOI: 10.1016/j.jbspin.2023.105676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Mickaël Dalecky
- Grenoble INP, TIMC-IMAG, CNRS, CHU de Grenoble-Alpes, University Grenoble-Alpes, 38000 Grenoble, France; Department of Rheumatology, CHU de Grenoble-Alpes, University Grenoble-Alpes, 38000 Grenoble, France.
| | - Tiphaine Dujardin
- Department of Rheumatology, CHU de Grenoble-Alpes, University Grenoble-Alpes, 38000 Grenoble, France
| | - Arnaud Pflimlin
- Department of Rheumatology, hôpital Ambroise-Paré, AP-HP, Boulogne-Billancourt, France
| | - Athan Baillet
- Grenoble INP, TIMC-IMAG, CNRS, CHU de Grenoble-Alpes, University Grenoble-Alpes, 38000 Grenoble, France; Department of Rheumatology, CHU de Grenoble-Alpes, University Grenoble-Alpes, 38000 Grenoble, France
| | - Xavier Romand
- Grenoble INP, TIMC-IMAG, CNRS, CHU de Grenoble-Alpes, University Grenoble-Alpes, 38000 Grenoble, France; Department of Rheumatology, CHU de Grenoble-Alpes, University Grenoble-Alpes, 38000 Grenoble, France
| |
Collapse
|
3
|
Zamout P, Exarchou S, Sharma A, Turesson C. The prevalence of chronic obstructive pulmonary disease in patients with spondyloarthritis compared to the general population in the southernmost region of Sweden: a case-control study. Clin Exp Med 2024; 24:75. [PMID: 38598034 PMCID: PMC11006728 DOI: 10.1007/s10238-024-01335-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
Spondyloarthritis (SpA) has been associated with comorbidities, e.g., cardiovascular disease. However, little is known about the relation between SpA and chronic obstructive pulmonary disease (COPD). The aim of the study was to compare the prevalence of COPD in SpA to the general population. Patients with prevalent SpA in Skåne, Sweden, on December 31, 2018, were identified based on diagnostic codes in a regional register on primary care, secondary outpatient care and inpatient care. Population-based controls (5 per SpA case) were matched for age, sex and municipality. The base case definition for COPD required at least two prior visits with a registered COPD diagnosis. Stricter definitions included dispensed prescriptions for COPD and a COPD diagnosis made by a specialist in lung medicine. The prevalence of COPD in patients with SpA and controls, overall and stratified by sex and age, and the corresponding prevalence ratios, were estimated. A total of 3571 patients with SpA (51% male, mean age 53 years) were compared to 17,855 matched controls. The prevalence of COPD in patients with SpA was 37.8/1000, with a prevalence ratio compared to controls of 1.03 (95% CI 0.85-1.24). There were no significant differences in COPD prevalence between patients with SpA and controls in men or women, in any of the age groups, or in analyses using stricter definitions of COPD. In this regional study including data from primary care, the prevalence of COPD was not increased in patients with SpA compared to the background population.
Collapse
Affiliation(s)
- Petros Zamout
- Section of Rheumatology, Örnsköldsvik Hospital, Örnsköldsvik, Sweden
| | - Sofia Exarchou
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms Gata 1B, 205 02, Malmö, Sweden
| | - Ankita Sharma
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms Gata 1B, 205 02, Malmö, Sweden
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms Gata 1B, 205 02, Malmö, Sweden.
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden.
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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: 0] [Impact Index Per Article: 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.
Collapse
Affiliation(s)
- Hatice Bodur
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Türkiye.
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Eid S, Sharif K, McGonagle D, Patt YS, Tsur AM, Adawi M, Cohen AD, Amital H, Watad A. Ankylosing spondylitis is associated with increased prevalence of valvular heart diseases: a cross-sectional population-based study. Postgrad Med J 2023; 99:1088-1093. [PMID: 37302111 DOI: 10.1093/postmj/qgad045] [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: 11/28/2022] [Revised: 02/22/2023] [Accepted: 05/06/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a chronic inflammatory arthritis primarily affecting the sacroiliac joint and axial skeleton with associated extra-articular involvement including cardiovascular system disease including aortic valve disease with variable reported prevalence. The aim of this study is to determine the prevalence of heart valve disorders in AS patients. METHODS This was a retrospective, population-based, cross-sectional study that retrieved data from the Clalit Health Services registry. Cases were defined as having AS, whereas controls were frequency matched by age and sex in a ratio of 5:1. The prevalence of valvular heart diseases was compared between the two groups; a multivariate logistic regression model was applied to estimate the association after controlling for potential confounders. RESULTS We included 4082 AS patients and 20 397 controls frequency matched by age and sex. AS patients had a significantly higher prevalence of cardiovascular risk factors (P < .001) and a higher prevalence of valvular heart disease. In the multivariate logistic regression model, adjusting for multiple confounding factors, AS was independently associated with aortic stenosis [odds ratio (OR): 2.25, 95% confidence interval (CI): 1.57-3.23, P < 0.001], aortic insufficiency (OR: 2.44, 95% CI: 1.50-3.94, P < 0.001), and mitral insufficiency (OR: 1.75, 95% CI: 1.17-2.61, P < 0.001) but not mitral stenosis (OR: 1.31, 95% CI: 0.60-2.70, P = 0.47). CONCLUSIONS Our study reports the increased risk of valvular heart diseases in patients with AS, possibly due to the inflammatory milieu associated with the disease process and the result of biomechanical stress affecting the enthesis-like valvular structures.
Collapse
Affiliation(s)
- Siwar Eid
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Kassem Sharif
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer 5262100, Israel
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer 5262100, Israel
| | - Dennis McGonagle
- Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Molecular Medicine, University of Leeds, Chapel Allerton Hospital, Leeds LS7 4SA, United Kingdom
| | - Yonatan Shneor Patt
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer 5262100, Israel
| | - Avishai M Tsur
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer 5262100, Israel
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer 5262100, Israel
- Medical Corps, Israel Defense Forces, Tel Hashomer, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Mohammad Adawi
- Faculty of Medicine, Bar Ilan University, Ramat Gan 5290002, Israel
- Rheumatology Unit, Puria Medical Center, Tiberias 1712, Israel
| | - Arnon D Cohen
- Chief Physicians Office, Clalit Health Services, Tel Aviv 6209804, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Howard Amital
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer 5262100, Israel
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer 5262100, Israel
| | - Abdulla Watad
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer 5262100, Israel
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer 5262100, Israel
- Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Molecular Medicine, University of Leeds, Chapel Allerton Hospital, Leeds LS7 4SA, United Kingdom
| |
Collapse
|
8
|
Mogard E, Bremander A, Haglund E. A combination of two or more unhealthy lifestyle factors is associated with impaired physical and mental health in patients with spondyloarthritis: a cross-sectional study. BMC Rheumatol 2022; 6:29. [PMID: 35610662 PMCID: PMC9131533 DOI: 10.1186/s41927-022-00260-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing knowledge of how individual lifestyle factors affect patients with spondyloarthritis, while studies exploring the combination of unhealthy lifestyle factors are lacking. Thus, our aim was to study the frequency of two or more unhealthy lifestyle factors and their associations with physical and mental health in patients with spondyloarthritis (SpA). METHODS A population-based postal survey involving questions on lifestyle factors was completed by 1793 patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and undifferentiated spondyloarthritis (USpA). Self-reported physical activity, body mass index, and tobacco use were respectively dichotomized as "healthy" or "unhealthy", summarized for each patient and stratified into four groups (0-3; 0 = no unhealthy lifestyle factors). Group comparisons were performed with Chi-squared tests, and associations with physical and mental health outcomes were performed with analysis of covariance and logistic regression analysis. RESULTS Out of 1426 patients (52% women) with complete information for all studied lifestyle factors, 43% reported ≥ two unhealthy lifestyle factors-more frequently patients with PsA (48%) than AS (39%) or USpA (38%)-and with no difference between women and men (p = 0.399). Two or more unhealthy lifestyle factors were associated with worse health-related quality of life, disease activity, physical function, pain, fatigue, anxiety, and depression, adjusted for age and SpA-subgroup. If an unhealthy level of physical activity was one of the two unhealthy lifestyle factors, patients reported worse health outcomes. CONCLUSION Reporting two or more unhealthy lifestyle factors were associated with worse physical and mental health in patients with SpA. This highlights the need to screen for a combination of unhealthy lifestyle factors and offer individualized coordinated interventions, and tailored coaching to support behavioral change, in order to promote sustainable health.
Collapse
Affiliation(s)
- Elisabeth Mogard
- Department of Clinical Sciences Lund, Rheumatology, Skane University Hospital, Lund University, Lund, Sweden.
| | - Ann Bremander
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, Lund, Sweden.,Spenshult Research and Development Centre, Halmstad, Sweden.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Emma Haglund
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, Lund, Sweden.,Spenshult Research and Development Centre, Halmstad, Sweden.,Rydberg Laboratory of Applied Sciences, Halmstad University, Halmstad, Sweden
| |
Collapse
|
9
|
Park HS, Laiz A, Díaz Del Campo P, Martín Martínez MA, Guerra-Rodriguez M, Alonso-Martin C, Sanchez-Vega J, Corominas H. Prevalence and Risk for Bundle Branch Block, Atrioventricular Block and Pacemaker Implantation in Spondyloarthritis. A Systematic Review of the Literature. Front Med (Lausanne) 2022; 9:851483. [PMID: 35402464 PMCID: PMC8990789 DOI: 10.3389/fmed.2022.851483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/16/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To evaluate the evidence regarding the prevalence and risk of bundle branch block (BBB), atrioventricular block (AVB) and pacemaker implantation (PMI) in patients with spondyloarthritis compared to a control group without spondyloarthritis. Methods A systematic review of the literature was performed using Pubmed (Medline), EMBASE (Elsevier) and Cochrane Library (Wiley) databases until December 2021. The prevalence and risk for AVB, BBB and PMI were analyzed. Cohort, case control and cross-sectional studies in patients ≥18 years meeting the classification criteria for spondyloarthritis were included. The Odds ratio (OR), risk ratio (RR), or Hazard ratio (HR) and prevalence difference were considered as outcomes. Data was synthesized in a previously defined extraction form which included a risk of bias assessment using the Newcastle-Ottawa Scale. Results In total, eight out of 374 studies were included. None of the studies provided results regarding the risk of low grade AVB and BBB in SpA patients. Only indirect results comparing prevalences from low to medium quality studies were found. According to population based registries, the sex and age adjusted HR of AVB was 2.3 (95% CI 1.6–3.3) in ankylosing spondylitis, 2.9 (95% CI 1.8–4.7) in undifferentiated spondyloarthritis and 1.5 (95% CI 1.1 a 1.9) in psoriatic arthritis. The absolute risk for AVB was 0.4% (moderate to high; 95% CI 0.34%-0.69%) for AS, 0.33% (moderate to high; 95% CI 0.21%-0.53%) for uSpA and 0.34% (moderate to high; 95% CI 0.26%-0.45%) for PsA.The RR for PMI in AS patients was 1.3 (95% CI 1.16–1.46) for groups aged between 65 and 69 years, 1.33 (95% CI 1.22–1.44) for 70–75 years, 1.24 (95% CI 1.55–1.33) for 75–79 years and 1.11 (95% CI 1.06–1.17) for groups older than 80 years. The absolute risk for PMI in AS patients was 0.7% (moderate to high risk; 95% CI 0.6–0.8%) for groups aged between 65–69, 1.44% (high risk; 95% CI 1.33–1.6%) for 70–75 years, 2.09% (high risk; 95% CI 2.0–2.2%) for 75–79 years and 4.15% (high risk; 95% CI 4.0–4.3%) for groups older than 80 years Conclusions Very few cases of low grade AVB and BBB were observed in observational studies. No study evaluated association measures for low grade AVB and BBB but the differences of prevalence were similar in SpA and control groups even though studies lacked the power to detect statistical differences. According to population based registries there was an approximately two fold-increased risk of high grade AVB in SpA patients. RR for PMI was higher in younger age groups.
Collapse
Affiliation(s)
- Hye Sang Park
- Department of Rheumatology, Hospital Dos de Maig, Barcelona, Spain.,Department of Rheumatology and Autoimmune Diseases, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ana Laiz
- Department of Rheumatology and Autoimmune Diseases, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - María A Martín Martínez
- Unidad de Investigación, Spanish Society of Rheumatology, Madrid, Spain.,Department of Cardiology, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Jesus Sanchez-Vega
- Department of Cardiology, Hospital Universitari Bellvitge, Hospitalet de Llobregat, Universitat de Barcelona (UB), Barcelona, Spain
| | - Hector Corominas
- Department of Rheumatology, Hospital Dos de Maig, Barcelona, Spain.,Department of Rheumatology and Autoimmune Diseases, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| |
Collapse
|
10
|
Min HK, Kim HR, Lee SH, Park S, Park M, Hong YS, Kim MY, Park SH, Kang KY. Increased risks of aortic regurgitation and atrial fibrillation in radiographic axial spondyloarthritis patients: a 10-year nationwide cohort study. Ther Adv Musculoskelet Dis 2022; 14:1759720X221088094. [PMID: 35368372 PMCID: PMC8972938 DOI: 10.1177/1759720x221088094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background: To compare the incidences of aortic regurgitation, atrial fibrillation (AF), and atrioventricular (AV) block II–III between radiographic axial spondyloarthritis (r-axSpA) patients and the general population (GP). Methods: National Health Insurance Services data were used. R-axSpA patients (N = 8877) and the age- and sex-matched GP (N = 26,631) were followed from August 2006 to December 2019. Incidence rates and standardized incidence ratios (SIRs) of aortic regurgitation, AF, and AV block II–III were compared between these groups. Ten-year incidence rates and hazard ratios (HRs) were calculated by the Kaplan–Meier method and Cox regression analysis. Results: Incidence rates of aortic regurgitation, AV block II–III, and AF in the r-axSpA group were 0.42, 0.21, and 4.0 per 1000 person-years (PYs), respectively. In the r-axSpA group, the SIR for aortic regurgitation was highest among 40- to 49-year-old men (4.11). Incidence rates of aortic regurgitation and AF were higher in the r-axSpA group than in the GP group (0.42 versus 0.18 per 1000 PYs 4.00 versus 3.13 per 1000 PYs, both p < 0.001, respectively), whereas the difference was insignificant for AV block II–III (0.21 versus 0.14 per 1000 PYs, p = 0.222). In multivariate analysis, r-axSpA was associated with a higher hazard (risk) for the development of aortic regurgitation and AF [HR (95% confidence interval) = 2.55 (1.49–4.37) and 1.20 (1.04–1.39), respectively], but the difference was insignificant for AV block II–III [HR (95% confidence interval) = 1.17 (0.59–2.31)]. Conclusions: Compared with the GP, r-axSpA patients are at increased risk of aortic regurgitation and AF, but not AV block II–III. These patients should be carefully monitored for occurrence of aortic regurgitation and AF.
Collapse
Affiliation(s)
- Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Sang-Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Sojeong Park
- Data Science Team, Hanmi Pharmaceuticals Co., Ltd., Seoul, South Korea
| | - Minae Park
- Data Science Team, Hanmi Pharmaceuticals Co., Ltd., Seoul, South Korea
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Moon-Young Kim
- Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, #56 Dongsu-Ro, Bupyung-Gu, Incheon KS006, South Korea
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul KS013, South Korea
| |
Collapse
|
11
|
The Prevalence of Cardiac Diseases in a Contemporary Large Cohort of Dutch Elderly Ankylosing Spondylitis Patients-The CARDAS Study. J Clin Med 2021; 10:jcm10215069. [PMID: 34768587 PMCID: PMC8584336 DOI: 10.3390/jcm10215069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 01/05/2023] Open
Abstract
Objectives: The aim of the present study was to determine the prevalence of specific cardiac manifestations, i.e., conduction disorders, valvular disease and diastolic left ventricular (LV) dysfunction, in a large cross-sectional controlled cohort of elderly ankylosing spondylitis (AS) patients. Methods: This cross-sectional study assessed the prevalence of valvular disease, conduction disorders and LV dysfunction in 193 randomly selected AS patients compared with 74 osteoarthritis (OA) controls aged 50–75 years. Patients underwent conventional and tissue Doppler echocardiography in combination with clinical and laboratory assessments. Multivariate regression analyses were performed to compare the odds of mitral valve regurgitation (MVR) and aortic valve regurgitation (AVR) between AS patients and OA controls. Results: The prevalence of diastolic dysfunction was trivial and comparable in AS patients compared to controls (respectively, 4% and 3%) and had no further clinical relevance. In addition, the prevalence of conduction disturbances was similar in both groups, with little clinical relevance, respectively 23% vs. 24%. The prevalence of AVR was significantly higher in AS patients compared to the controls, respectively 23% (9% trace, 12% mild, 1% moderate, 1% severe, 1% prosthesis) vs. 11%, p = 0.04. After correcting for age, sex and CV risk factors, AS patients had an odds ratio of 4.5 (95% CI 1.1–13.6) for AVR compared to the controls. In contrast, the prevalence values of MVR were similar and mostly not clinically relevant in AS patients and controls, respectively 36% and 32% and p = 0.46. Conclusion: The prevalence of diastolic LV dysfunction and conduction disorders was mostly not clinically relevant, and similar in AS patients and controls. However, AS patients had an up to five times increased odds to develop AVR compared to controls. Therefore, echocardiographic screening of elderly (50–75 years) AS patients should be considered.
Collapse
|
12
|
Park HS, Laiz A, Sanchez-Vega J, Díaz Del Campo P, Martín-Martínez MA, Guerra-Rodríguez M, Corominas H. Valve Abnormalities, Risk Factors for Heart Valve Disease and Valve Replacement Surgery in Spondyloarthritis. A Systematic Review of the Literature. Front Cardiovasc Med 2021; 8:719523. [PMID: 34631824 PMCID: PMC8498574 DOI: 10.3389/fcvm.2021.719523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022] Open
Abstract
Objective: Evaluate the evidence on the abnormalities of the aortic root and heart valves, risk and prognostic factors for heart valve disease and valve replacement surgery in spondyloarthritis. Methods: A systematic literature review was performed using Medline, EMBASE and Cochrane databases until July 2021. Prevalence, incidence, risk and prognostic factors for heart valve disease; dimension, morphology, and pathological abnormalities of the valves were analyzed. Patient characteristics (younger age, history of cardiac disease or longer disease duration) and period of realization were considered for the analysis. The SIGN Approach was used for rating the quality of the evidence of the studies. Results: In total, 37 out of 555 studies were included. Overall, the level of evidence was low. The incidence of aortic insufficiency was 2.5–3.9‰. Hazard Ratio for aortic insufficiency was 1.8–2.0. Relative risk for aortic valve replacement surgery in ankylosing spondylitis patients was 1.22–1.46. Odds ratio for aortic insufficiency was 1.07 for age and 1.05 for disease duration. Mitral valve abnormalities described were mitral valve prolapse, calcification, and thickening. Aortic valve abnormalities described were calcification, thickening and an echocardiographic “subaortic bump.” Abnormalities of the aorta described were thickening of the wall and aortic root dilatation. The most common microscopic findings were scarring of the adventitia, lymphocytic infiltration, and intimal proliferation. Conclusions: A higher prevalence and risk of aortic valve disease is observed in patients with ankylosing spondylitis. Studies were heterogeneous and analysis was not adjusted by potential confounders. Most studies did not define accurate outcomes and may have detected small effects as being statistically significant.
Collapse
Affiliation(s)
- Hye-Sang Park
- Rheumatology Department, Hospital Dos de Maig, Barcelona, Spain
| | - Ana Laiz
- Rheumatology and Autoimmune Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jesus Sanchez-Vega
- Cardiology Department, Hospital Universitari Bellvitge, Hospitalet de Llobregat, Spain.,Department of Medicine, Universitat de Barcelona (UB), Barcelona, Spain
| | | | | | | | - Hector Corominas
- Rheumatology Department, Hospital Dos de Maig, Barcelona, Spain.,Rheumatology and Autoimmune Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| |
Collapse
|
13
|
Stovall R, Peloquin C, Felson D, Neogi T, Dubreuil M. Relation of therapies for ankylosing spondylitis and psoriatic arthritis to risk of myocardial infarction: a nested case control study. BMC Rheumatol 2021; 5:36. [PMID: 34321112 PMCID: PMC8320220 DOI: 10.1186/s41927-021-00207-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/04/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Risk of myocardial infarction (MI) is elevated in ankylosing spondylitis and psoriatic arthritis (AS/PsA) compared to the general population. We evaluated the risk of MI related to the use of tumor necrosis factor inhibitor (TNFi) and other therapies in AS/PsA. METHODS We conducted a nested case-control study using 1994-2018 data from OptumLabs® Data Warehouse, which includes de-identified medical and pharmacy claims, laboratory results, and enrollment records for commercial and Medicare Advantage enrollees. The database contains longitudinal health information on enrollees and patients, representing a diverse mixture of ages, ethnicities and geographical regions across the United States. Assessing AS/PsA separately, MI cases were matched to 4 controls by sex, age, diagnosis year and insurance type. We evaluated treatment within 6 months prior to MI including NSAIDs (AS referent), disease-modifying anti-rheumatic drug (DMARDs; PsA referent) and TNFi alone or in combinations. We evaluated the relation of treatment categories to MI risk using conditional logistical regression adjusting for confounders. RESULTS Among 26,648 AS subjects, there were 237 MI cases and 894 matched controls. Among 43,734 PsA subjects, there were 404 cases and 1596 controls. In AS, relative to NSAID use, the adjusted odds ratio (aOR) for MI among TNFi only users was 0.85 (95% CI 0.39-1.85) and for DMARD only users was 1.04 (95% CI 0.65-1.68). In PsA, relative to DMARD use, the aOR among TNFi only was 1.09 (95% CI 0.74-1.60). Combination therapies also had no effect. CONCLUSIONS Among AS/PsA, no combination of therapies appeared to be protective or harmful with regards to MI. Future studies should capture more AS and PsA patients and include longer term follow up to further investigate this question.
Collapse
Affiliation(s)
| | - Christine Peloquin
- Section of Rheumatology, Boston University School of Medicine, 650 Albany Street, X-200, Boston, MA, 02118, USA
| | - David Felson
- Section of Rheumatology, Boston University School of Medicine, 650 Albany Street, X-200, Boston, MA, 02118, USA
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, 650 Albany Street, X-200, Boston, MA, 02118, USA
| | - Maureen Dubreuil
- Section of Rheumatology, Boston University School of Medicine, 650 Albany Street, X-200, Boston, MA, 02118, USA.
- OptumLabs Visiting Scholar, OptumLabs, Eden Prairie, MN, USA.
| |
Collapse
|
14
|
Eddarami J, Azzouzi H, Ichchou L. Heart Involvement in a Moroccan Population with Spondyloarthritis: A Cross-sectional Study. J Saudi Heart Assoc 2021; 33:191-197. [PMID: 34307015 PMCID: PMC8294134 DOI: 10.37616/2212-5043.1258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 01/31/2023] Open
Abstract
Objectives The aim of this study was to investigate the prevalence of cardiac manifestations and their predictive factors in Moroccan patients with spondyloarthritis (SpA). Methods We have conducted a cross-sectional study over four months at the Department of Rheumatology in Mohammed VI University Hospital of Oujda, Morocco. All SpA patients fulfilled the 2009 Assessment SpondyloArthritis international Society (ASAS) criteria. Every patient had a cardiac check up including clinical examination, 12-lead electrocardiogram (ECG) and transthoracic echocardiography (TTE). Multiple logistic regression was used to analyze the associated factors with cardiac manifestations. Results We included 64 men and 30 women with a mean age of 37.32 ± 12.65 years old. The mean disease duration was 10.60 ± 7.61 years. Patients had a mean Ankylosing Spondylitis Disease Activity Score (ASDAS) CRP of 2.25 ± 1.38, a mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of 2.88 ± 2.26 and a mean Bath Ankylosing Spondylitis Functional Index (BASFI) of 33.52 ± 30.49. Traditional cardiovascular risk factors (CVRF) included dyslipidemia in 14.9%, hypertension in 9.6% and type 2 diabetes in 7.4% of the cases. Eight patients (8.5%) smoked and 3 patients (3.2%) used alcohol whereas 20 patients (21.3%) had a history of smoking and 5 patients (6.3%) a history of alcohol. Cardiac manifestations were found in 12 patients (13.3%): 3.3% had aortic regurgitation (AR), 1.1% had aortic dilatation, 1.1% had aortic valve thickening (AVT), 2.2% had mitral thickening, 1.1% had mitral regurgitation (MR), 1.1% had mitral stenosis (MS), 3.3 had pericarditis and 2.2% had complete right bundle branch block (RBBB). In multivariate analysis, cardiac involvement was significantly associated with extra-articular manifestations (OR = 6.05; 95% CI: 1.197-30.607, p = 0.029). Conclusion Based on these results, cardiac involvement was common and associated with the severity of the disease; hence, early detection of cardiac abnormalities and targeted treatment strategies of SpA and comorbidities are necessary to control the systemic inflammation and improve the excess of cardiovascular mortality in this group of patients.
Collapse
Affiliation(s)
- Jalila Eddarami
- Department of Rheumatology, Mohamed VI University Hospital, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
| | - Hamida Azzouzi
- Department of Rheumatology, Mohamed VI University Hospital, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
| | - Linda Ichchou
- Department of Rheumatology, Mohamed VI University Hospital, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
| |
Collapse
|
15
|
Siao WZ, Liu CH, Wang YH, Wei JCC, Jong GP. Increased risk of valvular heart disease in patients with ankylosing spondylitis: a nationwide population-based longitudinal cohort study. Ther Adv Musculoskelet Dis 2021; 13:1759720X211021676. [PMID: 34211590 PMCID: PMC8216336 DOI: 10.1177/1759720x211021676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/11/2021] [Indexed: 01/19/2023] Open
Abstract
Aims: We aimed to evaluate the risk of valvular heart disease (VHD) among patients with ankylosing spondylitis (AS). Methods: This was a population-based cohort study utilizing the Longitudinal Health Insurance Research Database of the National Health Insurance in Taiwan. Patients with and without coding of newly diagnosed AS from 1999 to 2013 were assigned to the AS and non-AS groups, respectively. Primary outcome was the incidental risk of VHD. Multiple Cox regression was used to estimate the adjusted hazard ratio of VHD. Subgroup analysis and sensitivity tests were also conducted. Results: The AS group included 3780 patients, and 22,680 matched subjects without an AS diagnosis were identified as controls. The AS group had an increased risk of VHD compared with non-AS controls (adjusted hazard ratio: 1.63; 95% confidence interval: 1.43–1.86; p < 0.001). Subgroup analysis also revealed an increased risk of individual types of VHD, including aortic, mitral, and tricuspid valve disease. Patients in the AS group had a higher incidence of valve replacement surgery after the onset of VHD. Conclusion: Patients with AS had a significant risk of VHD compared to non-AS controls in this population-based cohort study. Screening for VHD may be needed in caring patients with AS. We suggest that echocardiography may be performed when patients are diagnosed with AS.
Collapse
Affiliation(s)
- Wun-Zhih Siao
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung
| | - Chin-Hsiu Liu
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung
| | - Gwo-Ping Jong
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital and Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Road, Taichung, 40201
| |
Collapse
|
16
|
Karmacharya P, Ogdie A, Eder L. Psoriatic arthritis and the association with cardiometabolic disease: a narrative review. Ther Adv Musculoskelet Dis 2021; 13:1759720X21998279. [PMID: 33737966 PMCID: PMC7934027 DOI: 10.1177/1759720x21998279] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/06/2021] [Indexed: 12/20/2022] Open
Abstract
Psoriatic arthritis (PsA) is associated with a higher burden of cardiometabolic disorders, such as hypertension, dyslipidemia, diabetes, obesity, and cardiovascular disease (CVD), compared with the general population. These comorbidities are associated with the severity of disease, and adversely affect treatment outcomes in PsA. Comorbidities lead to increased physician visits and medications for patients and make the selection and maintenance of therapies challenging for physicians. Moreover, CVD is a leading cause of mortality in PsA. Therefore, optimal management of PsA should include not only treating the skin and joint disease, but also identifying comorbidities early, and managing them to improve long-term outcomes. Further studies are needed to understand the complex mechanisms, interactions, and trajectories of cardiometabolic comorbidities in psoriatic disease.
Collapse
Affiliation(s)
| | - Alexis Ogdie
- Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lihi Eder
- Department of Medicine/Rheumatology, Women's College Hospital, University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada
| |
Collapse
|
17
|
Ma Y, Pan Z, Fan D, Xu S, Pan F. The increased risk of atrial fibrillation in inflammatory arthritis: a systematic review and meta-analysis of cohort studies. Immunol Invest 2021; 51:1095-1107. [PMID: 33563055 DOI: 10.1080/08820139.2021.1884091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia contributing to stroke and sudden cardiac death. Numbers of studies indicated that patients with inflammatory arthritis have an increased risk of AF. The present study aims to assess the risk of AF in inflammatory arthritis patients.Methods: We systematically searched cohort studies regarding the risk of AF in patients with rheumatoid arthritis, or spondyloarthritis through PubMed, Web of Science, Cochrane Library, Clinical Trials Registry, and China National Knowledge from inception to August 1, 2019. Meta-analysis was performed using fixed effect model, estimating both crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Subgroup analysis and meta-regression based on geographic characteristics, comorbidities, and medication use were conducted to explore the source of heterogeneity.Results: Literature search identified 388 potentially relevant studies, and five studies containing seven cohorts of rheumatoid arthritis or spondyloarthritis were included in the meta-analysis. The AF risk of inflammatory arthritis patients was significantly increased compared with health controls (HR = 1.42, 95% CI: 1.36 to 1.49, Z = 14.17, P < .001), and the pooled HR of studies adjusted factor, like demographic characteristics, medications use, and comorbidities, was 1.37 (95% CI: 1.29 to 1.46; Z = 9.82, P < .001).Conclusion: Patients with inflammatory arthritis have increased risk of AF, probably due to the underlying chronic inflammation. Although various confounders have been adjusted like medications use and comorbidities, the risk of AF is still significantly increased in inflammatory arthritis patients.Abbreviations: AF: Atrial fibrillation; AS: Ankylosing spondylitis; CI: Confidence interval; HR: Hazard ratio; NOS: Newcastle-Ottawa scale; NSAIDs: Non-steroid anti-inflammatory drugs; PsA: Psoriatic arthritis; RA: Rheumatoid arthritis; SpA: Spondyloarthritis; TNFi: Tumor necrosis factors inhibitor; uSpA: Undifferentiated spondyloarthritis.
Collapse
Affiliation(s)
- Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, China
| | - Zhipeng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Department of Medical Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Dazhi Fan
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Shanshan Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, China
| |
Collapse
|
18
|
Almasi S, Farahani B, Samiei N, Rezaei Y, Mahmoodi H, Qorbani M. Echocardiographic and Electrocardiographic Findings in Patients with Ankylosing Spondylitis without Cardiovascular Risk Factors. J Tehran Heart Cent 2021; 15:43-49. [PMID: 33552193 PMCID: PMC7825462 DOI: 10.18502/jthc.v15i2.4182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Ankylosing spondylitis (AS) is a chronic inflammatory condition associated with more cardiac manifestations than those in the normal population. In this study, we sought to determine the prevalence of cardiac involvement in patients suffering from AS without cardiovascular risk factors. Methods: The present case-control study, conducted in 2 university hospitals in Tehran from January 2016 to December 2017, recruited 67 patients with AS and 40 age- and sex-matched healthy controls. The diagnosis of AS was based on the classification criteria of the Assessment of SpondyloArthritis International Society. All the participants were examined using transthoracic echocardiography and a standard 12-lead ECG. Baseline characteristics, echocardiographic findings, and ECG features were compared between the AS and control groups using univariate analyses. Results: The median age was 33.5 (IQR25-75%: 20.5–59) years in the AS group and 35 (IQR25-75%: 26–59) years in the control group (P=0.301). The number of patients with left ventricular systolic and diastolic dysfunction was significantly higher in the patients with AS than in the controls (7.5% vs. 20.9%; P=0.067, and 22.9% vs. 5.0%; P=0.026, respectively). The number of individuals with a left-axis deviation and a left anterior fascicular block was significantly higher in the patients suffering from AS than in the control group. The number of patients with aortic valve involvement was comparable between the groups (P=0.332). Conclusion: The most common cardiac involvement in our patients with AS was left ventricular dysfunction, followed by rhythm disturbances and aortic valve insufficiency. These findings were independent of age, AS severity, and disease duration. Therefore, the implementation of cardiovascular screening can be recommended for patients with AS.
Collapse
Affiliation(s)
- Simin Almasi
- Rheumatology Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Behzad Farahani
- Department of Cardiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Samiei
- Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Rezaei
- Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Habib Mahmoodi
- Department of Internal Medicine, Firoozgar Hospital, Iran University of Medical Sciences , Tehran, Iran
| | - Mostafa Qorbani
- Department of Public Health, Alborz University of Medical Sciences, Karaj, Iran.,Noncommunicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
19
|
Papagoras C, Voulgari PV, Drosos AA. Cardiovascular Disease in Spondyloarthritides. Curr Vasc Pharmacol 2020; 18:473-487. [PMID: 31330576 DOI: 10.2174/1570161117666190426164306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/13/2019] [Accepted: 04/13/2019] [Indexed: 12/15/2022]
Abstract
The spondyloarthritides are a group of chronic systemic inflammatory joint diseases, the main types being ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Evidence accumulating during the last decades suggests that patients with AS or PsA carry an increased risk for cardiovascular disease and cardiovascular death. This risk appears to be mediated by systemic inflammation over and above classical cardiovascular risk factors. The excess cardiovascular risk in those patients has been formally acknowledged by scientific organizations, which have called physicians' attention to the matter. The application by Rheumatologists of new effective anti-rheumatic treatments and treat-to-target strategies seems to benefit patients from a cardiovascular point of view, as well. However, more data are needed in order to verify whether anti-rheumatic treatments do have an effect on cardiovascular risk and whether there are differences among them in this regard. Most importantly, a higher level of awareness of the cardiovascular risk is needed among patients and healthcare providers, better tools to recognize at-risk patients and, ultimately, commitment to address in parallel both the musculoskeletal and the cardiovascular aspect of the disease.
Collapse
Affiliation(s)
- Charalampos Papagoras
- 1st Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Paraskevi V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| |
Collapse
|
20
|
Södergren A, Askling J, Bengtsson K, Forsblad-d'Elia H, Jernberg T, Lindström U, Ljung L, Mantel Ä, Jacobsson LTH. Characteristics and outcome of a first acute myocardial infarction in patients with ankylosing spondylitis. Clin Rheumatol 2020; 40:1321-1329. [PMID: 32845439 PMCID: PMC7943508 DOI: 10.1007/s10067-020-05354-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022]
Abstract
Objectives To study clinical characteristics, mortality, and secondary prevention, after a first incident acute myocardial infarction (AMI) in patients with ankylosing spondylitis (AS) compared with the general population. Methods In total, 292 subjects with AS and a first AMI between Jan 2006 and Dec 2014 were identified using the Swedish national patient register. Each subject was matched with up to 5 general population comparators per AS-patient (n = 1276). Follow-up started at the date of admission for AMI and extended until death or 365 days of follow-up. Cox regression was used to assess mortality in two time intervals: days 0–30 and days 31–365. For a subgroup with available data, clinical presentation at admission, course, treatment for AMI, and secondary prevention were compared. Results During the 365-day follow-up, 56/292 (19%) AS patients and 184/1276 (14%) comparators died. There were no difference in mortality due to cardiovascular-related causes, although the overall mortality day 31–365 was increased among patients with AS compared with comparators (HR [95% CI] = 2.0 [1.3;3.0]). At admission, AS patients had a higher prevalence of cardiovascular comorbidities compared with comparators. At discharge, patients with AS were less often prescribed lipid-lowering drugs and non-aspirin antiplatelet therapy. Conclusions Patients with AS tend to have a higher comorbidity burden at admission for first AMI. The mortality after a first AMI due to cardiovascular-related causes does not seem to be elevated, despite an increased overall mortality during days 31–365 among patients with AS compared with the general population.Key Points • The all-cause mortality after a first AMI was higher in patients with AS. • Mortality after a first AMI due to CVD-related causes does not seem to be elevated for patients with AS. • In patients with AS suffering a first AMI, more attention should be given to other comorbidities causing an excess in mortality. |
Electronic supplementary material The online version of this article (10.1007/s10067-020-05354-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anna Södergren
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden. .,Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden.
| | - Johan Askling
- Clinical Epidemiology Section, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Karin Bengtsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Helena Forsblad-d'Elia
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lotta Ljung
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden.,Clinical Epidemiology Section, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ängla Mantel
- Clinical Epidemiology Section, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
21
|
Forsblad-d'Elia H, Law L, Bengtsson K, Smeds J, Ketonen M, Sundström B, Ljung L, Geijer M, Söderberg S, Lindqvist P. Biomechanical Properties of Common Carotid Arteries Assessed by Circumferential 2D Strain and β Stiffness Index in Patients With Ankylosing Spondylitis. J Rheumatol 2020; 48:352-360. [PMID: 32611672 DOI: 10.3899/jrheum.200146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Ankylosing spondylitis (AS) is associated with an elevated risk of cardiovascular disease (CVD) related to atherosclerosis, preceded by arterial stiffness. We aimed to examine common carotid artery (CCA) biomechanical properties using ultrasound to calculate β stiffness index (indicating arterial stiffness) and, a more recently developed technique, 2-dimensional (2D) speckle tracking strain (indicating arterial motion and deformation, strain) to (1) compare with age- and sex-matched controls, and (2) analyze relationships between strain and stiffness with disease characteristics and traditional risk factors for CVD in patients with AS. METHODS In this cross-sectional study, a cohort of 149 patients with AS, mean age 55.3 ± 11.2 years, 102 (68.5%) men, and 146 (98%) HLA-B27-positive, were examined. Bilateral CCA were examined for circumferential 2D strain and β stiffness index. A subgroup of 46 patients was compared with 46 age- and sex-matched controls, both groups without hypertensive disease, diabetes, myocardial infarction, or stroke. RESULTS Mean bilateral circumferential 2D strain was lower in AS patients compared with controls (7.9 ± 2.6% vs 10.3 ± 1.9%, P < 0.001), whereas mean bilateral β stiffness index was higher (13.1 ± 1.7 mmHg/mm vs 12.3 ± 1.3 mmHg/mm, P = 0.02). In multivariable linear regression analyses, strain was associated with age, erythrocyte sedimentation rate, history of anterior uveitis, and treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARD) and/or biological DMARD (R2 0.33), while stiffness was associated with age (R2 0.19). CONCLUSION Both CCA circumferential 2D strain and β stiffness index differed between patients with AS and controls. Strain was associated with AS-related factors and age, whereas only age was associated with stiffness, suggesting that the obtained results reflect different pathogenic vascular processes.
Collapse
Affiliation(s)
- Helena Forsblad-d'Elia
- H. Forsblad-d'Elia, MD, L. Law, BSc, J. Smeds, MD, B. Sundström, RPT, L. Ljung, MD, Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå;
| | - Lucy Law
- H. Forsblad-d'Elia, MD, L. Law, BSc, J. Smeds, MD, B. Sundström, RPT, L. Ljung, MD, Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå
| | - Karin Bengtsson
- K. Bengtsson, MD, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Region Västra Götaland, Sahlgrenska University Hospital, Department of Rheumatology, Gothenburg
| | - Johan Smeds
- H. Forsblad-d'Elia, MD, L. Law, BSc, J. Smeds, MD, B. Sundström, RPT, L. Ljung, MD, Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå
| | - Maria Ketonen
- M. Ketonen, MD, Department of Surgical and Perioperative Sciences, Clinical Physiology, Umeå University, Umeå
| | - Björn Sundström
- H. Forsblad-d'Elia, MD, L. Law, BSc, J. Smeds, MD, B. Sundström, RPT, L. Ljung, MD, Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå
| | - Lotta Ljung
- H. Forsblad-d'Elia, MD, L. Law, BSc, J. Smeds, MD, B. Sundström, RPT, L. Ljung, MD, Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå
| | - Mats Geijer
- M. Geijer, MD, Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, and Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology, Gothenburg and Faculty of Medicine, Lund University, Lund
| | - Stefan Söderberg
- S. Söderberg, MD, Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå
| | - Per Lindqvist
- P. Lindqvist, BSc, Department of Surgical and Perioperative Sciences, Clinical Physiology, Umeå University, Umeå, Sweden
| |
Collapse
|
22
|
Abstract
PURPOSE OF REVIEW Cardiac involvement in patients with ankylosing spondylitis (AS) generally manifests itself as aortic insufficiency, aortitis, disturbance in cardiac conduction, and myocardial dysfunction. We have used a case-based approach to review the current state of the art knowledge regarding the diagnosis and management of aortic valve disease and aortitis in patients with AS. RECENT FINDINGS The risk for aortic valve disease and aortic valve replacement or repair is significantly higher than in people without AS, and this risk increases with age. Echocardiography, cardiac MRI, and CT can serve as effective tools for screening and follow-up. Surgical repair/replacement remains the mainstay of therapy for aortic insufficiency and aortic dilation, whereas transcatheter-based techniques may be favorable in the setting of aortic stenosis. Aortic valve and atrioventricular conduction abnormalities contribute to overall cardiovascular burden in AS. Optimal timing and therapeutic technique are dependent on assessment of overall risk and serial follow-up.
Collapse
|
23
|
Packer M. Link Between Synovial and Myocardial Inflammation: Conceptual Framework to Explain the Pathogenesis of Heart Failure with Preserved Ejection Fraction in Patients with Systemic Rheumatic Diseases. Card Fail Rev 2020. [DOI: 10.15420/cfr.2019.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Patients with a broad range of systemic rheumatic diseases are at increased risk of heart failure (HF), an event that is not related to traditional cardiovascular risk factors or underlying ischaemic heart disease. The magnitude of risk is linked to the severity of arthritic activity, and HF is typically accompanied by a preserved ejection fraction. Subclinical evidence for myocardial fibrosis, microcirculatory dysfunction and elevated cardiac filling pressures is present in a large proportion of patients with rheumatic diseases, particularly those with meaningful systemic inflammation. Drugs that act to attenuate pro-inflammatory pathways (methotrexate and antagonists of tumour necrosis factor and interleukin-1) may ameliorate myocardial inflammation and cardiac structural abnormalities and reduce the risk of HF events.
Collapse
Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, US and Imperial College, London, UK
| |
Collapse
|
24
|
Lai Y, Zhang Y, Mo S, Ma J, Ni T, Lei Z, Xia J, Xu C. Prevalence of comorbidities and risk factors in spondyloarthritis: results of a cross-sectional study. Ann Rheum Dis 2020; 81:e43. [PMID: 32213499 DOI: 10.1136/annrheumdis-2020-217313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Yupeng Lai
- Rheumatology and Immunology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China
| | - Yanpeng Zhang
- Laboratory, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China
| | - Shaozhen Mo
- Rheumatology and Immunology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China
| | - Jinsheng Ma
- Rehabilitation Medicine, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China
| | - Tongxin Ni
- Cardiology, Shenzhen University General Hospital, Shenzhen, Guangdong Province, China
| | - Zhihao Lei
- Neurology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China
| | - Jun Xia
- Radiology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China
| | - Chiduo Xu
- Rheumatology and Immunology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China
| |
Collapse
|
25
|
Kiltz U, Braun J, Becker A, Chenot JF, Dreimann M, Hammel L, Heiligenhaus A, Hermann KG, Klett R, Krause D, Kreitner KF, Lange U, Lauterbach A, Mau W, Mössner R, Oberschelp U, Philipp S, Pleyer U, Rudwaleit M, Schneider E, Schulte TL, Sieper J, Stallmach A, Swoboda B, Winking M. [Long version on the S3 guidelines for axial spondyloarthritis including Bechterew's disease and early forms, Update 2019 : Evidence-based guidelines of the German Society for Rheumatology (DGRh) and participating medical scientific specialist societies and other organizations]. Z Rheumatol 2020; 78:3-64. [PMID: 31784900 DOI: 10.1007/s00393-019-0670-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | | | - A Becker
- Allgemeinmedizin, präventive und rehabilitative Medizin, Universität Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Deutschland
| | | | - J-F Chenot
- Universitätsmedizin Greifswald, Fleischmann Str. 6, 17485, Greifswald, Deutschland
| | - M Dreimann
- Zentrum für Operative Medizin, Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Deutschland
| | | | - L Hammel
- Geschäftsstelle des Bundesverbandes der DVMB, Metzgergasse 16, 97421, Schweinfurt, Deutschland
| | | | - A Heiligenhaus
- Augenzentrum und Uveitis-Zentrum, St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | | | - K-G Hermann
- Institut für Radiologie, Charité Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | | | - R Klett
- Praxis Manuelle & Osteopathische Medizin, Fichtenweg 17, 35428, Langgöns, Deutschland
| | | | - D Krause
- , Friedrich-Ebert-Str. 2, 45964, Gladbeck, Deutschland
| | - K-F Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - U Lange
- Kerckhoff-Klinik, Rheumazentrum, Osteologie & Physikalische Medizin, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | | | - A Lauterbach
- Schule für Physiotherapie, Orthopädische Universitätsklinik Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt, Deutschland
| | | | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland
| | - R Mössner
- Klinik für Dermatologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | | | - U Oberschelp
- , Barlachstr. 6, 59368, Werne a.d. L., Deutschland
| | | | - S Philipp
- Praxis für Dermatologie, Bernauer Str. 66, 16515, Oranienburg, Deutschland
| | - U Pleyer
- Campus Virchow-Klinikum, Charité Centrum 16, Klinik f. Augenheilkunde, Charité, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Rudwaleit
- Klinikum Bielefeld, An der Rosenhöhe 27, 33647, Bielefeld, Deutschland
| | - E Schneider
- Abt. Fachübergreifende Frührehabilitation und Sportmedizin, St. Antonius Hospital, Dechant-Deckersstr. 8, 52249, Eschweiler, Deutschland
| | - T L Schulte
- Klinik für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik, Ruhr-Universität Bochum, Gudrunstr. 65, 44791, Bochum, Deutschland
| | - J Sieper
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07743, Jena, Deutschland
| | | | - B Swoboda
- Abteilung für Orthopädie und Rheumatologie, Orthopädische Universitätsklinik, Malteser Waldkrankenhaus St. Marien, 91054, Erlangen, Deutschland
| | | | - M Winking
- Zentrum für Wirbelsäulenchirurgie, Klinikum Osnabrück, Am Finkenhügel 3, 49076, Osnabrück, Deutschland
| | | |
Collapse
|
26
|
Lazzerini PE, Laghi-Pasini F, Boutjdir M, Capecchi PL. Commentary: Systemic effects of IL-17 in inflammatory arthritis. Front Cardiovasc Med 2019; 6:183. [PMID: 31921897 PMCID: PMC6914728 DOI: 10.3389/fcvm.2019.00183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/25/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Franco Laghi-Pasini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Mohamed Boutjdir
- VA New York Harbor Healthcare System, SUNY Downstate Medical Center, New York, NY, United States.,NYU School of Medicine, New York, NY, United States
| | - Pier Leopoldo Capecchi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| |
Collapse
|
27
|
Bengtsson K, Klingberg E, Deminger A, Wallberg H, Jacobsson LTH, Bergfeldt L, Forsblad-d'Elia H. Cardiac conduction disturbances in patients with ankylosing spondylitis: results from a 5-year follow-up cohort study. RMD Open 2019; 5:e001053. [PMID: 31798955 PMCID: PMC6861087 DOI: 10.1136/rmdopen-2019-001053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/27/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
Objectives To describe electrocardiographic (ECG) development in patients with ankylosing spondylitis (AS) and identify associations between baseline characteristics and cardiac conduction disturbances (CCD) at 5-year follow-up. Methods In a longitudinal cohort study, 172 patients (54% men, mean age (SD) of 50 (13) years at baseline) with AS underwent ECG, physical examination, questionnaires and laboratory testing at baseline and at 5-year follow-up. Descriptive statistics and univariate and age- and sex-adjusted logistic regression analyses were used. CCD included both atrioventricular and intraventricular blocks. Results Twenty-three of the 172 patients (13.4%) had a CCD at follow-up. Eight patients had developed a new CCD and eight had normalised their ECG. In the age- and sex-adjusted analyses, CCD at baseline (OR 24.8, 95% CI 7.3 to 84.5), male sex (OR 6.4, 95% CI 2.0 to 20.8), history of anterior uveitis (OR 4.4, 95% CI 1.3 to 14.5), higher ASDAS-CRP (OR 2.3, 95% CI 1.3 to 4.0), greater waist circumference (OR 1.3, 95% CI 1.1 to 1.6, per 5 cm), and medication with antiplatelets (OR 7.0, 95% CI 1.5 to 31.8) and beta-blockers (OR 3.4, 95% CI 1.0 to 11.5) were associated with a CCD at follow-up. Higher age and longer symptom duration were highly correlated and were both associated with a CCD at follow-up. Conclusions The presence of CCD in AS is in part dynamic and associated with both AS and non-AS characteristics. Our results suggest that patients especially prone to present with CCDs are older men with a previous CCD, longer symptom duration, higher AS disease activity, a history of anterior uveitis and medication reflecting cardiovascular disease.
Collapse
Affiliation(s)
- Karin Bengtsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology, Sahlgrenska University Hospital, Västra Götalandsregionen, Gothenburg, Sweden
| | - Eva Klingberg
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology, Sahlgrenska University Hospital, Västra Götalandsregionen, Gothenburg, Sweden
| | - Anna Deminger
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology, Sahlgrenska University Hospital, Västra Götalandsregionen, Gothenburg, Sweden
| | - Hanna Wallberg
- Department of Anesthesiology and Intensive Care, NU Hospital Group, Västra Götalandsregionen, Trollhättan, Sweden
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology, Sahlgrenska University Hospital, Västra Götalandsregionen, Gothenburg, Sweden
| | - Lennart Bergfeldt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Västra Götalandsregionen, Gothenburg, Sweden
| | - Helena Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
| |
Collapse
|
28
|
Abstract
Background The likelihoods of valvular heart disease ( VHD ) and conduction abnormalities in patients with ankylosing spondylitis ( AS p) are poorly defined. Knowing their lifetime risks of VHD and pacemaker use would help inform whether cardiac screening should be done. Methods and Results Patients with AS p and a comparison group without AS p were identified among US Medicare beneficiaries in 1999 to 2013. Frequencies of VHD and pacemaker use were compared in 4 age groups: 65 to 69 years, 70 to 74 years, 75 to 79 years, and 80 years or older, as were rates of valve surgeries, a measure of VHD severity, and new pacemaker insertions. Outcomes were compared between 42 327 patients with AS p and 19 211 703 patients without AS p. The prevalence of aortic valve disease in patients with AS p increased with age (2.6%, 6.7%, 10.9%, and 17.1%), as did the prevalence of mitral valve disease. Risks of VHD were slightly but significantly higher in patients with AS p (adjusted odds ratios 1.06-1.51). Rates of aortic valve replacement/repair were also higher in patients with AS p than in the comparison group (125 versus 93; 183 versus 149; 261 versus 208; 279 versus 191 per 100 000 patient-years in the 4 age groups). Rates of mitral valve surgery did not differ between groups. Among patients with AS p, pacemaker use ranged from 1.0% to 7.6% across age groups, and was slightly higher than in controls (odds ratio range 1.11-1.32). Conclusions Lifetime risks of VHD and pacemaker use in AS p increase markedly with age, but are only slightly higher than in elderly people without AS p.
Collapse
Affiliation(s)
- Michael M Ward
- 1 Intramural Research Program National Institute of Arthritis and Musculoskeletal and Skin Diseases National Institutes of Health Bethesda MD
| |
Collapse
|
29
|
Ikeoka K, Nishikawa N, Sakakibara M, Kawamoto K, Hoshida S. Transient severe conduction disturbances associated with ankylosing spondylitis. J Arrhythm 2019; 35:689-691. [PMID: 31410244 PMCID: PMC6686291 DOI: 10.1002/joa3.12218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 01/14/2023] Open
Abstract
A 46-year-old man presented with advanced and complete atrioventricular block. He was diagnosed with human leukocyte antigen-B27-positive ankylosing spondylitis (AS) and treated with nonsteroidal anti-inflammatory drugs for AS. The severe atrioventricular block spontaneously improved and resolved after 3 months of therapy. Sequential cardiac magnetic resonance imaging demonstrated transient myocardial high-intensity signals in the basal septum close to the membranous portion of the septum. A pacemaker was not needed because of the reversible atrioventricular block.
Collapse
Affiliation(s)
- Kuniyasu Ikeoka
- Department of Cardiovascular MedicineNTT West Osaka HospitalOsakaJapan
| | | | | | - Keisuke Kawamoto
- Division of Rheumatology, Department of Internal MedicineNTT West Osaka HospitalOsakaJapan
| | - Shiro Hoshida
- Department of Cardiovascular MedicineYao Municipal HospitalYaoJapan
| |
Collapse
|
30
|
Klingberg E, Bilberg A, Björkman S, Hedberg M, Jacobsson L, Forsblad-d'Elia H, Carlsten H, Eliasson B, Larsson I. Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study. Arthritis Res Ther 2019; 21:17. [PMID: 30635024 PMCID: PMC6330463 DOI: 10.1186/s13075-019-1810-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/02/2019] [Indexed: 11/26/2022] Open
Abstract
Background Obesity is over-represented in patients with psoriatic arthritis (PsA) and associated with higher disease activity, poorer effect of treatment and increased cardiovascular morbidity. Studies on the effects of weight loss are however needed. This study aimed to prospectively study the effects of weight loss treatment with very low energy diet (VLED) on disease activity in patients with PsA (CASPAR criteria) and obesity (body mass index BMI ≥ 33 kg/m2). Methods VLED (640 kcal/day) was taken during 12–16 weeks, depending on pre-treatment BMI. Afterwards, an energy-restricted diet was gradually reintroduced. Weight loss treatment was given within a structured framework for support and medical follow-up. Treatment with conventional synthetic and/or biologic disease-modifying anti-rheumatic drugs was held constant from 3 months before, until 6 months after baseline. Patients were assessed with BMI, 66/68 joints count, Leeds enthesitis index, psoriasis body surface area (BSA), questionnaires and CRP at baseline, 3 and 6 months. Primary outcome was the percentage of patients reaching minimal disease activity (MDA) and secondary outcomes were reaching Psoriatic Arthritis Response Criteria (PsARC) and American College of Rheumatology (ACR) response criteria. Results Totally 41/46 patients completed the study, 63% women, median age 54 years (IQR 48–62). At baseline increased BMI was associated with higher disease activity and poorer function. The median weight loss was 18.7 kg (IQR 14.6–26.5) or 18.6% (IQR 14.7–26.3) of the baseline weight. A majority of the disease activity parameters improved significantly after weight loss, including 68/66 tender/swollen joints count, CRP, BSA, Leeds enthesitis index, HAQ and patient VAS for global health, pain and fatigue. A larger weight loss resulted in more improvement in a dose-response manner. The percentage of patients with MDA increased from 29 to 54%, (p = 0.002). PsARC was reached by 46.3%. The ACR 20, 50 and 70 responses were 51.2%, 34.1% and 7.3% respectively. Conclusions Short-term weight loss treatment with VLED was associated with significant positive effects on disease activity in joints, entheses and skin in patients with PsA and obesity. The study supports the hypothesis of obesity as a promotor of disease activity in PsA. Trial registration ClinicalTrials.gov identifier: NCT02917434, registered on September 21, 2016—retrospectively registered Electronic supplementary material The online version of this article (10.1186/s13075-019-1810-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Eva Klingberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Annelie Bilberg
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Sofia Björkman
- Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Martin Hedberg
- Department of Rheumatology, Hospital of Borås, Borås, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Helena Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
| | - Hans Carlsten
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Björn Eliasson
- Department of Medicine, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Ingrid Larsson
- Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
31
|
Moon I, Choi EK, Jung JH, Han KD, Choi YJ, Park J, Cho JH, Lee E, Choe W, Lee SR, Cha MJ, Lim WH, Oh S. Ankylosing spondylitis: A novel risk factor for atrial fibrillation - A nationwide population-based study. Int J Cardiol 2018; 275:77-82. [PMID: 30360993 DOI: 10.1016/j.ijcard.2018.10.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/24/2018] [Accepted: 10/05/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease, associated with a number of cardiovascular diseases. We sought to investigate whether AS increases the risk of atrial fibrillation (AF) in a nationwide population-based study. METHODS A total of 14,129 patients newly diagnosed with AS (mean age 41.8 ± 15.3 years, 72% male) were recruited from the Korean National Health Insurance Service database between 2010 and 2014 and followed up for new onset AF. Age- and sex-matched non-AS subjects (1:5, n = 70,645) were selected and compared with the AS patients. RESULTS During a mean follow-up of 3.5 years, AF was newly diagnosed in 486 patients (114 patients of the AS group). The AS patients developed AF more frequently than the non-AS subjects (2.32 vs. 1.51 per 1000 person-years). In multivariate Cox regression analysis, AS was an independent risk factor for AF (Hazard ratio [HR] 1.28, 95% confidence interval [1.03-1.58]). The AS with tumor necrosis factor inhibitor (TNFi) therapy group showed higher risk for AF (HR 1.60 [1.02-2.39]). In younger patients of the AS group (patients <40 years old), the risk for AF was three times higher than patients at same age in the non-AS group. AS was an independent risk factor for AF in men, but not in women (HR 1.53 [1.18-1.95]; HR 1.42 [0.94-2.08], respectively). CONCLUSIONS AS was an independent risk factor for AF, especially in those under 40 years of age and those administered TNFi. It would be reasonable to screen for AF and stroke prevention in these high-risk patients.
Collapse
Affiliation(s)
- Inki Moon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Jin-Hyung Jung
- Department of Biostatistics, College of Medicine, The Catholic University of, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of, Seoul, Republic of Korea
| | - You-Jung Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jiesuck Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jun Hwan Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Euijae Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wonseok Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Soon Chun Hyang University Hospital Seoul, Seoul, Republic of Korea
| | - Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo-Hyun Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
32
|
Black-Maier E, Daubert JP. Editorial Commentary: Prevention and treatment of atrial fibrillation: Is hyperuricemia the next target? Trends Cardiovasc Med 2018; 29:48-49. [PMID: 30057151 DOI: 10.1016/j.tcm.2018.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Eric Black-Maier
- Duke Center for Atrial Fibrillation, Electrophysiology Section, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - James P Daubert
- Duke Center for Atrial Fibrillation, Electrophysiology Section, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
| |
Collapse
|