Relationship between cellular communication network factor 1 (CCN1) and carotid atherosclerosis in patients with rheumatoid arthritis

BACKGROUND

The cellular communication network factor 1 (CCN1) is one of the matricellular proteins of the CCN family involved in chronic inflammatory disorders like rheumatoid arthritis (RA) and involved in human atherosclerotic lesions. This study was aimed to assess the levels of serum CCN1 in patients with rheumatoid arthritis (RA), evaluating its relation to carotid intima-media thickness (CIMT) and predisposition to subclinical carotid atherosclerosis and its impact on activity of RA disease.

MATERIALS AND METHODS

This is a case-control study that included 105 RA patients classified into active and inactive groups according to disease activity score (DAS28) with 50 healthy matched controls. Clinical and laboratory assessments were done including enzyme-linked immunosorbent assay (ELISA) measurement of CCN1 with a bilateral assessment of CIMT using high resolutionultrasonography. Comparison of CCN1 between RA patients and controls, a correlation between CCN1, DAS28, swollen joint count (SJC), tender joint count (TJC), and CIMT were analyzed.

RESULTS

There was significant elevation of CCN1 in RA patients compared to controls (235.62±62.5 vs. 73.11±18.2, respectively). The cut off value of CCN1 was 99.25 pg/ml, with an area under the curve (AUC) =0.995, p<0.001, 98 % sensitivity and 95% specificity. CCN1 was inversely correlated with DAS28 and its components in both active and inactive RA patients (r=- 0.92, r=- 0.94, p<0.001). CCN1 was inversely correlated with SJC (r= -0.64, r= - 0.67, p<0.001), TJC (r=- 0.56, r= - 0.63, p<0.001), and with Larsen xray score (r=- 0.68, r= - 0.78, p<0.001) in both active and inactive RA patients, respectively. The CCN1 levels in active RA patients were significantly lower than that in patients with low disease activity. A significant positive correlation between CCN1 levels and CIMT in RA patient groups (r=0.88, r=0.47, p<0.001, respectively) was found.

CONCLUSION

Serum CCN1 could be a helpful biomarker in the diagnosis of RA, associated with RA remission. Disruption of serum CCN1 is engaged in the pathogenesis of atherosclerosis in RA patients which could be a clue for a future treatment strategy of atherosclerosis in RA by controlling CCN1 disruption. Regular follow-up of RA patients is recommended for early detection of subclinical atherosclerosis. New research ideas for controlling CCN1 disruption as new aspects of atherosclerosis treatment in RA patients are needed.

Prevalence of Subclinical Carotid Atherosclerosis and Vitamin D Deficiency in Egyptian Ankylosing Spondylitis Patients

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.