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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Stanek A, Romuk E, Wielkoszyński T, Brożyna-Tkaczyk K, Wziątek-Kuczmik D, Cholewka A. The Impact of Whole-Body Cryotherapy on Endothelium Parameters in Patients with Ankylosing Spondylitis. Antioxidants (Basel) 2023; 12. [PMID: 36830079 DOI: 10.3390/antiox12020521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The aim of the study was to assess the effect of whole-body cryotherapy (WBC) with subsequent exercise training (WBC group) or exercise-only training (ET group) on endothelium inflammation parameters in patients with ankylosing spondylitis (AS). METHODS The WBC procedure lasted 3 min, and exercise training consisted of one 60 min session a day, which was the same in each group. The ET group was compared to the WBC group. Endothelium (high-sensitivity C-reactive protein (hsCRP), soluble P-Selectin, soluble vascular cell adhesion molecule-1 (sVCAM-1), neopterin), and oxidative stress (lipid hydroperoxide (LHP), protein sulfhydryl (PSH), lipofuscin, paraoxonase-1(PON-1), and albumin) parameters were estimated 1 day before and 1 day after the completion of the study. RESULTS A significant decrease in hsCRP, sP-Selectin, sVCAM-1, and neopterin concentrations was observed in the WBC group after the treatment. After the treatment, in both groups, LHP and lipofuscin levels and PON-1 activity decreased significantly. The observed drop in these parameters was higher in the WBC group compared to the ET group. Albumin concentration increased in the WBC group after treatment. CONCLUSION Procedures of WBC have a beneficial effect on endothelium parameters in AS patients; therefore, this method can be applied in the treatment of this group of patients.
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Aicha BT, Ahmed F, Seif B, Ines M, Leila R, Selma B, Rawdha T, Olfa S, Habiba M, Leila A. Spinal radiographic progression is correlated with preclinical atherosclerosis in spondyloarthritis. J Back Musculoskelet Rehabil 2022; 36:701-708. [PMID: 36565100 DOI: 10.3233/bmr-220141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND A higher prevalence of cardiovascular risk was observed in spondyloarthritis (SpA). The relationship between disease-related factors structural damage and subclinical atherosclerosis is still unknown. OBJECTIVE The aim of our study was to evaluate the association of subclinical atherosclerosis with radiographic structural damage in patients with SpA. METHODS Forty-seven SpA patients who fulfilled the ASAS criteria were enrolled in a case-control study conducted over 12 months and compared with 47 age and sex-matched healthy controls. None of the subjects had a previous history of cardiovascular diseases or cardiovascular risk factors. Demographic and disease characteristics were recorded. Structural lesions were evaluated using plain radiography, and two scoring tools were used to spine (BASRI and mSASSS). Subclinical atherosclerosis was assessed using ultrasound measurements of flow-mediated dilation (FMD) and carotid intima-media thickness (cIMT). RESULTS The median age of patients was 36 years. The sex ratio was 2.35. The median BASRI total score was 3 (IQR 2-4), median mSASSS score was 10 (IQR 415). cIMT was significantly increased in SpA patients compared to controls (p< 0.0001), and FMD was significantly lower in patients than in healthy subjects (p= 0.008). cIMT was significantly associated with ankylosis of the facet joints (p= 0.035) and Romanus spondylitis (p= 005). FMD was negatively associated with vertebral squaring (p= 0049), bridging syndesmophytes (p= 0031) and mSASSS score (p= 0.047). CONCLUSION Our result supports the association of radiographic structural damage and subclinical atherosclerosis assessed using cIMT and FMD. This finding highlights the importance of earlier treatment in order to prevent radiographic damage progression and atherosclerotic events.
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Affiliation(s)
- Ben Tekaya Aicha
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Fendri Ahmed
- Radiology Department, La Rabta Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Boukriba Seif
- Radiology Department, La Rabta Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Mahmoud Ines
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Rouached Leila
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Bouden Selma
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Tekaya Rawdha
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Saidane Olfa
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Mizouni Habiba
- Radiology Department, La Rabta Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Abdelmoula Leila
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
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Kuk M, Ward NC, Dwivedi G. Extrinsic and Intrinsic Responses in the Development and Progression of Atherosclerosis. Heart Lung Circ 2021; 30:807-816. [PMID: 33468387 DOI: 10.1016/j.hlc.2020.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/10/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022]
Abstract
Atherosclerosis is a multifactorial disease that is thought to be primarily inflammatory in origin. Given the contribution of inflammation to the development and progression of atherosclerosis, other conditions that are characterised by a dysregulated inflammatory response have also been proposed to play a role. The purpose of this review is to organise and present the various inflammatory processes that can affect atherosclerosis into two broad categories: extrinsic or host-independent and intrinsic or host-dependent. Within these two categories, we will discuss various processes that may contribute to the development and progression of atherosclerosis and the clinical studies describing these associations. Although the clinical trials investigating anti-inflammatory therapies have to date provided mixed results, further studies, particularly in conjunction with lipid-lowering and blood pressure lowering therapies should be considered.
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Affiliation(s)
- Mariya Kuk
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada; McGill University Health Centre, McGill University, Montreal, Canada
| | - Natalie C Ward
- School of Public Health, Curtin University, Perth, WA, Australia; Medical School, University of Western Australia, Perth, WA, Australia
| | - Girish Dwivedi
- Medical School, University of Western Australia, Perth, WA, Australia; Harry Perkins Institute for Medical Research, Fiona Stanley Hospital, Perth, WA, Australia.
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Fotoh DS, Serag DM, Badr IT, Saif DS. Prevalence of Subclinical Carotid Atherosclerosis and Vitamin D Deficiency in Egyptian Ankylosing Spondylitis Patients. Arch Rheumatol 2021; 35:335-342. [PMID: 33458656 PMCID: PMC7788658 DOI: 10.46497/archrheumatol.2020.7694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 10/05/2019] [Indexed: 12/23/2022] Open
Abstract
Objectives This study aims to investigate the relationship between subclinical carotid atherosclerosis and vitamin D deficiency in Egyptian ankylosing spondylitis (AS) patients and their impact on disease activity. Patients and methods This cross-sectional study included 40 AS patients (36 males, 4 females; mean age 45.9±8.4 years; range 33 to 55 years) diagnosed according to the 1984 modified New York criteria with equal number of healthy controls (26 males, 14 females; mean age 48.4±7.8 years; range 31 to 55 years). Patients' histories were taken and clinical examinations were performed. Disease activity was assessed with Bath AS metrology index (BASMI), Bath AS disease activity index (BASDAI), and Bath AS functional index (BASFI) scores. Laboratory evaluation included lipid profile and 25-hydroxyvitamin D [25(OH)D] was determined by enzyme-linked immunosorbent assay. Bilateral carotid intima-media thickness (CIMT) was measured by a high-resolution ultrasound with linear 7-12 MHz transducer. Average of CIMT of right and left common carotid arteries was used. Results Statistically significant differences were found between patients and controls in terms of CIMT (p<0.001), 25(OH)D3 (p<0.001) and triglycerides (p=0.02). A significant positive correlation was present between CIMT and disease duration (r=0.74), disease activity scores [BASFI (r=0.60), BASMI (r=0.49), BASDAI (r=0.65)] and lipid profile except for high-density lipoprotein (HDL) that had a negative correlation (r=-0.52). A significant negative correlation was present between 25(OH)D3 levels and CIMT (r=-0.38) and lipid profile except for HDL having a positive correlation (r=0.40). Conclusion Prevalence of subclinical carotid atherosclerosis in AS patients compared to the healthy population was associated with high disease activity and functional limitations. In AS patients, 25(OH)D3 deficiency is a risk factor for accelerated atherosclerosis.
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Affiliation(s)
- Dina Salem Fotoh
- Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Dena Mamdouh Serag
- Department of Radiology, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Ismail Tawfeek Badr
- Department of Orthopedic, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Dalia Salah Saif
- Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
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Prati C, Demougeot C, Guillot X, Sondag M, Verhoeven F, Wendling D. Vascular involvement in axial spondyloarthropathies. Joint Bone Spine 2019; 86:159-63. [DOI: 10.1016/j.jbspin.2018.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 12/19/2022]
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7
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Bai R, Zhang Y, Liu W, Ma C, Chen X, Yang J, Sun D. The Relationship of Ankylosing Spondylitis and Subclinical Atherosclerosis: A Systemic Review and Meta-Analysis. Angiology 2018; 70:492-500. [PMID: 30497278 DOI: 10.1177/0003319718814309] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Ruocen Bai
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yanfen Zhang
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wen Liu
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xin Chen
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Dandan Sun
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
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Scriffignano S, Perrotta FM, De Socio A, Lubrano E. Role of comorbidities in spondyloarthritis including psoriatic arthritis. Clin Rheumatol 2018; 38:3-10. [DOI: 10.1007/s10067-018-4332-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 02/06/2023]
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9
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Yuan Y, Yang J, Zhang X, Han R, Chen M, Hu X, Ma Y, Wu M, Wang M, Xu S, Pan F. Carotid Intima-Media Thickness in Patients with Ankylosing Spondylitis: A Systematic Review and Updated Meta-Analysis. J Atheroscler Thromb 2018; 26:260-271. [PMID: 30089757 PMCID: PMC6402883 DOI: 10.5551/jat.45294] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: Inflammatory arthritis (IA) diseases are relevant with subclinical atherosclerosis, but the data in ankylosing spondylitis (AS) were inconsistent. Therefore, we performed this meta-analysis to explore the relationship between the marker of subclinical atherosclerosis (carotid intima-media thickness (IMT)) and AS. Methods: We performed a systematic literature review using PubMed, Web of Science, Chinese National Knowledge Infrastructure (CNKI) and Chinese Biomedical Database (CBM) databases up to March 2018. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated to assess the association between carotid IMT and AS. Subgroup analysis, sensitivity analysis, and meta-regression were applied to explore the sources of heterogeneity, and publication bias was calculated to access the quality of pooled studies. Results: A total of 24 articles were collected. The carotid IMT was significantly increased in AS compared with healthy controls (SMD = 0.725, 95% CI = 0.443–1.008, p < 0.001). Subgroup analyses showed the Bath Ankylosing Spondylitis Activity Index (BASDAI) was the source of heterogeneity. Notably, IMT was not significantly increased in those studies that included > 50% patients treated with anti-TNF. Meta-regression revealed severe inflammation status (BASDAI and C-reactive protein (CRP)) could significantly impact carotid IMT in AS. Conclusions: Carotid IMT was significantly increased in patients with AS compared with healthy controls, which suggested subclinical atherosclerosis is related to AS.
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Affiliation(s)
- Yaping Yuan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Jiajia Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Xu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Renfang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Mengya Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Xingxing Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Meng Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Mengmeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Shengqian Xu
- Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
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Giollo A, Dalbeni A, Cioffi G, Ognibeni F, Gatti D, Idolazzi L, Orsolini G, Minuz P, Rossini M, Fava C, Viapiana O. Factors associated with accelerated subclinical atherosclerosis in patients with spondyloarthritis without overt cardiovascular disease. Clin Rheumatol 2017; 36:2487-95. [DOI: 10.1007/s10067-017-3786-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/19/2017] [Accepted: 08/07/2017] [Indexed: 12/14/2022]
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Abstract
OBJECTIVE Accelerated atherosclerosis associated with an enhanced inflammatory state, which characterizes ankylosing spondylitis (AS), is the leading cause of increased cardiovascular risk. The objective of this study was to assess carotid intima-media thickness (CIMT) as a surrogate for subclinical atherosclerosis in AS patients and its possible correlation with disease-related clinical parameters. METHODS We performed a prospective study of 30 consecutive patients meeting modified New York criteria for AS compared to 25 controls matched for age and sex. Patients with traditional CV risk factors were excluded. Disease-specific measures and inflammatory measures (ESR, CRP, TNF-α, IL-6 and IL-1) were determined. CIMT was measured in the right common carotid artery using high-resolution B-mode ultrasound. RESULTS AS patients exhibited increased CIMT compared to matched healthy controls (0.62 ± 0.12 vs. 0.53 ± 0.09 mm). CIMT was positively correlated with age, disease duration, disease activity (BASDAI and ASDAS) and the inflammatory measures ESR (r = 0.45, P = 0.11) and TNF-α (r = 0.62, P < 0.001). CIMT did not correlate with the BMI, BASFI, IL-6, IL-1 or cholesterol levels. CONCLUSIONS This study shows increased CIMT in AS patients without traditional cardiovascular risk factors compared to healthy controls. An increase in age, disease duration, disease activity (BASDAI and ASDAS), biomarkers of inflammation (ESR and CRP) and TNF-α may predict the occurrence of accelerated atherosclerosis in AS.
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Affiliation(s)
- Inderjeet Verma
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, India
| | - Pawan Krishan
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, India
| | - Ashit Syngle
- Cardio Rheuma and Healing Touch City Clinic, Chandigarh and Rheumatologist Fortis Multi Specialty Hospital, Mohali, India.
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12
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Scarno A, Perrotta FM, Cardini F, Carboni A, Annibali G, Lubrano E, Spadaro A. Beyond the joint: Subclinical atherosclerosis in rheumatoid arthritis. World J Orthop 2014; 5:328-335. [PMID: 25035836 PMCID: PMC4095026 DOI: 10.5312/wjo.v5.i3.328] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/12/2014] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
Rheumatoid arthritis is a chronic autoimmune inflammatory disease associated with increased cardiovascular risk and higher mortality in respect to general population. Beyond joint disease, inflammation is the major determinant of accelerated atherosclerosis observed in rheumatoid arthritis. We review the relationship between inflammation, atherosclerosis and cardiovascular risk in rheumatoid arthritis, focusing on the assessment of subclinical atherosclerosis by functional and morphological methods. These tools include flow mediated dilatation, carotid intima-media thickness, ankle/brachial index, coronary calcium content, pulse wave analysis and serum biomarker of subclinical atherosclerosis.
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Fabbroni M, Cantarini L, Caso F, Costa L, Pagano VA, Frediani B, Manganelli S, Galeazzi M. Drug retention rates and treatment discontinuation among anti-TNF-α agents in psoriatic arthritis and ankylosing spondylitis in clinical practice. Mediators Inflamm 2014; 2014:862969. [PMID: 25110401 DOI: 10.1155/2014/862969] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/26/2014] [Accepted: 05/29/2014] [Indexed: 01/19/2023] Open
Abstract
Objective. The study aim was to determine treatment persistence rates and to identify causes of discontinuation in psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients in clinical practice. Methods. Patients treated with adalimumab (ADA), etanercept (ETA), or infliximab (INF) were retrospectively included. Treatment persistence rates were analyzed by means of a stepwise logistic regression. Differences between therapy duration were assessed by means of an analysis of variance model (ANOVA), while a chi-square test was used to evaluate relationships between therapies and causes of treatment discontinuation and the administration of concomitant disease-modifying antirheumatic drugs (DMARDs) among therapies and types of disease considering completed courses of therapy versus courses that were discontinued. Results. 268 patients received a total of 353 anti-TNF treatment courses (97 ADA, 180 ETA, and 76 INF). Comparison among therapies showed significant difference regarding the treatment persistence rates due to the contrast between ETA and INF (P = 0.0062). We observed that 84.7% of patients were still responding after 6 months of follow-up. Comparison among diseases showed that there were significant differences between PsA and AS (P = 0.0073) and PsA and PsA with predominant axial involvement (P = 0.0467) in terms of duration of the therapy, while there were no significant differences with regard to the persistence rate. Conclusions. In this cohort, anti-TNF-α therapy was associated with high drug persistence rates. As in rheumatoid arthritis, switching to another anti-TNF-α agent can be an effective option when, during the treatment of AS or PsA, therapy is suspended because of inefficacy or an adverse event. Combination therapy with DMARDs was associated with a better persistence rate.
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