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Mercader-Salvans J, García-González M, Quevedo-Abeledo JC, Quevedo-Rodríguez A, Gómez-Bernal F, Hernández-Díaz M, Pestana-Eliche M, Markthaler M, Martín-González C, Gómez-Moreno C, González-Gay MÁ, Ferraz-Amaro I. Red blood cell distribution width as a surrogate biomarker of damage and disease activity in patients with systemic lupus erythematosus. Clin Exp Rheumatol 2024:20529. [PMID: 38757296 DOI: 10.55563/clinexprheumatol/f0jnnm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/11/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES Red blood cell distribution width (RDW) is a measure of variability in mean corpuscular volume. Alterations in RDW can be observed in a variety of human disorders, including inflammatory, cardiovascular, and hepatic or renal diseases. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect virtually any organ in the body. In this work, our objective was to analyse how a complete characterisation of disease characteristics in a large series of patients with SLE is related to RDW values. METHODS 284 patients with SLE and 181 age- and sex-matched healthy controls were recruited. Complete blood count including RDW was assessed. Multivariable analysis was performed to analyse the relationship between RDW and SLE disease characteristics, including composite scores of disease activity and damage. RESULTS After multivariable adjustment, RDW was higher in patients with SLE compared to controls (beta coefficient 0.8 [95% confidence interval: 0.3-1] %, p=0.003). Several disease characteristics, such as the presence of extractable nuclear antibodies and antiphospholipid syndrome, and the use of prednisone and azathioprine, were significantly associated with higher levels of RDW after adjustment for confounders. Of note, cumulative disease damage and disease activity scores were associated with higher RDW values after controlling for covariates. CONCLUSIONS RDW may serve as a surrogate biomarker of accrual disease damage and activity in patients with SLE.
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Affiliation(s)
| | | | | | | | | | | | | | - Marcella Markthaler
- Division of Dermatology, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Cristina Gómez-Moreno
- Fundación Jiménez Díaz School of Nursing of Madrid, Autonomous University of Madrid, Spain
| | - Miguel Ángel González-Gay
- Division of Rheumatology, IIS-Fundación Jiménez Díaz, Madrid, and Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain.
| | - Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, and Department of Internal Medicine. Universidad de La Laguna (ULL), Tenerife, Spain.
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Merino de Paz N, Quevedo-Abeledo JC, Gómez-Bernal F, de Vera-González A, Abreu-González P, Martín-González C, González-Gay MÁ, Ferraz-Amaro I. Malondialdehyde Serum Levels in a Full Characterized Series of 430 Rheumatoid Arthritis Patients. J Clin Med 2024; 13:901. [PMID: 38337595 PMCID: PMC10856177 DOI: 10.3390/jcm13030901] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
Background. Oxidative stress has been involved in the pathogenesis of rheumatoid arthritis (RA). The serum malondialdehyde (MDA) level is a reliable biomarker of oxidative stress status. In the present work, we aimed to analyze how a comprehensive characterization of the disease characteristics in RA, including a lipid profile, insulin resistance, and subclinical atherosclerosis, relates to serum MDA levels. Methods. In a cross-sectional study that included 430 RA patients, serum MDA levels were evaluated. Multivariable analysis was performed to examine the relationship of MDA with disease activity scores and disease characteristics, including subclinical carotid atherosclerosis, a comprehensive lipid molecule profile, and indices of insulin resistance and beta cell function indices. Results. The erythrocyte sedimentation rate (ESR) showed a significant and positive relationship with MDA. However, this did not occur for other acute phase reactants such as C-reactive protein or interleukin-6. Although the DAS28-ESR score (Disease Activity Score in 28 joints) had a positive and significant association with MDA serum levels, other disease activity scores that do not use the erythrocyte sedimentation rate in their formula did not show a significant relationship with MDA. Other disease characteristics, such as disease duration and the existence of rheumatoid factor and antibodies against citrullinated protein, were not related to serum MDA levels. This also occurred for lipid profiles, insulin resistance indices, and subclinical carotid atherosclerosis, for which no associations with circulating MDA were found. Conclusions. The disease characteristics are not related to circulating MDA levels in patients with RA.
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Affiliation(s)
- Nayra Merino de Paz
- Division of Dermatology, Dermamedicin Clínicas, 38004 Santa Cruz de Tenerife, Spain;
| | | | - Fuensanta Gómez-Bernal
- Division of Central Laboratory, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (F.G.-B.); (A.d.V.-G.)
| | - Antonia de Vera-González
- Division of Central Laboratory, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (F.G.-B.); (A.d.V.-G.)
| | - Pedro Abreu-González
- Unit of Physiology, Department of Basic Medical Sciences, University of La Laguna, 38200 Tenerife, Spain;
| | | | - Miguel Ángel González-Gay
- Department of Medicine, University of Cantabria, 39005 Santander, Spain
- Division of Rheumatology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Iván Ferraz-Amaro
- Internal Medicine Department, Universidad de La Laguna, 38200 Tenerife, Spain;
- Division of Rheumatology, Hospital Universitario de Canarias, 38320 Tenerife, Spain
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3
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García-González M, Gómez-Bernal F, Quevedo-Abeledo JC, Fernández-Cladera Y, González-Rivero AF, López-Mejías R, Díaz-González F, González-Gay MÁ, Ferraz-Amaro I. The complement system is linked to insulin resistance in patients with systemic lupus erythematosus. Clin Exp Rheumatol 2024; 42:115-121. [PMID: 37706313 DOI: 10.55563/clinexprheumatol/t2k0hn] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/10/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES Systemic lupus erythematosus (SLE) patients more commonly have insulin resistance (IR) than control subjects. Recent studies have revealed that the complement (C) system is not only a mediator of the immune system but is also related to the pathogenesis of atherosclerosis in the general population. Given that the C alteration is a characteristic of SLE, in the present work we set out to analyse if there is a relationship between the C system and IR in patients with SLE. METHODS New generation functional assays of the three pathways of the C system were performed in 225 non-diabetic patients with SLE. In addition, the serum levels of inactive (C1q, C2, C3, C4, factor D), activated (C3a) and regulators (C1 inhibitor and factor H) molecules of the C system were evaluated. Insulin and C-peptide serum levels were measured, and insulin resistance and indices of beta cell function were calculated using the homeostatic model assessment (HOMA). Metabolic syndrome criteria fulfillments were applied. Multivariable linear regression analysis was performed to assess the relationship between C system and IR indices and the presence of metabolic syndrome. RESULTS After adjusting for covariates that included traditional cardiovascular risk factors associated with IR and prednisone, serum C3a and factor H levels were positively related to higher levels of the HOMA2-IR index. Besides, in the multivariable analysis, after adjustment for covariates, serum levels of C1q and C3 associated with a higher odds ratio for the presence of metabolic syndrome. CONCLUSIONS IR and metabolic syndrome are positively and independently related to higher serum levels of some serum C elements in patients with SLE with a predominant role of the alternative pathway elements.
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Affiliation(s)
| | | | | | | | | | - Raquel López-Mejías
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | - Miguel Ángel González-Gay
- Division of Rheumatology, IIS-Fundación Jiménez Díaz, Madrid; University of Cantabria, IDIVAL, Santander, Spain; and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, and Department of Internal Medicine, University of La Laguna (ULL), Tenerife, Spain.
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4
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González-Sierra M, Romo-Cordero A, Quevedo-Abeledo JC, Quevedo-Rodríguez A, Gómez-Bernal F, de Vera-González A, López-Mejías R, Martín-González C, González-Gay MÁ, Ferraz-Amaro I. Mean Platelet Volume in a Series of 315 Patients with Rheumatoid Arthritis: Relationship with Disease Characteristics, including Subclinical Atherosclerosis and Cardiovascular Comorbidity. Diagnostics (Basel) 2023; 13:3208. [PMID: 37892031 PMCID: PMC10605652 DOI: 10.3390/diagnostics13203208] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Mean platelet volume (MPV) refers to the average platelet size in femtoliters. Increased or decreased MPV has been associated with several disorders, including inflammatory and cardiovascular diseases. In the present study, our objective was to analyze the relationship of MPV with disease activity in a large and well-characterized series of patients with rheumatoid arthritis (RA). This is a cross-sectional study that included 315 patients with RA and 208 controls matched by sex and age. Complete blood count, including MPV, was assessed. Multivariable analysis was performed to examine the relationship of MPV with RA disease characteristics, carotid atherosclerosis, and traditional cardiovascular factors, including a comprehensive profile of lipid molecules and insulin resistance or beta cell function indices. The multivariable analysis, which includes other hematological modifications produced by the disease and platelet values, showed that MPV levels were significantly lower in RA patients than in controls. Erythrocyte sedimentation rate and interleukin-6, but not C-reactive protein, were negatively correlated with MPV after adjustment for covariates. Similarly, disease activity and MPV had a significant and independent negative correlation. No relationships were found between MPV and cardiovascular risk factors, lipid profile or insulin resistance indices or subclinical atherosclerosis. In conclusion, patients with RA have lower levels of MPV than controls. MPV is negatively related to acute phase reactants and disease activity in RA.
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Affiliation(s)
- Marta González-Sierra
- Division of Hospitalization-at-Home, Hospital Universitario de Canarias, 38320 Tenerife, Spain;
| | - Alejandro Romo-Cordero
- Division of Internal Medicine, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (A.R.-C.); (C.M.-G.)
| | - Juan Carlos Quevedo-Abeledo
- Division of Rheumatology, Hospital Universitario Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain (A.Q.-R.)
| | - Adrián Quevedo-Rodríguez
- Division of Rheumatology, Hospital Universitario Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain (A.Q.-R.)
| | - Fuensanta Gómez-Bernal
- Division of Central Laboratory, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (F.G.-B.); (A.d.V.-G.)
| | - Antonia de Vera-González
- Division of Central Laboratory, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (F.G.-B.); (A.d.V.-G.)
| | - Raquel López-Mejías
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Marqués de Valdecilla (IDIVAL), 39011 Santander, Spain;
| | - Candelaria Martín-González
- Division of Internal Medicine, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (A.R.-C.); (C.M.-G.)
- Internal Medicine Department, Universidad de La Laguna, 38200 Tenerife, Spain
| | - Miguel Ángel González-Gay
- Department of Medicine and Psychiatry, Universidad de Cantabria, 39005 Santander, Spain
- Division of Rheumatology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Iván Ferraz-Amaro
- Internal Medicine Department, Universidad de La Laguna, 38200 Tenerife, Spain
- Division of Rheumatology, Hospital Universitario de Canarias, 38320 Tenerife, Spain
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5
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Romo-Cordero A, González-Sierra M, Quevedo-Abeledo JC, Quevedo-Rodríguez A, Gómez-Bernal F, de Vera-González A, López-Mejías R, Jiménez-Sosa A, Martín-González C, González-Gay MÁ, Ferraz-Amaro I. The Ratio of Monocytes to HDL-Cholesterol Is Associated with Cardiovascular Risk and Insulin Resistance in Patients with Rheumatoid Arthritis. Life (Basel) 2023; 13:1995. [PMID: 37895377 PMCID: PMC10608697 DOI: 10.3390/life13101995] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
The monocytes to high-density lipoprotein (HDL)-cholesterol ratio (MHR) indicates inflammation based on the anti-inflammatory properties of HDL-cholesterol as well as the pro-inflammatory effect of monocytes. Several studies have investigated MHR in various disorders, specifically in cardiovascular diseases. Consequently, MHR has been significantly associated with cardiovascular and all-cause mortality in the general population, regardless of established risk factors. However, its role in the augmented risk of cardiovascular disease found in rheumatoid arthritis (RA) has not been studied to date. This is a cross-sectional study that encompassed 430 patients with RA and 208 controls matched by sex and age. Complete blood cell count and complete lipid profile were evaluated. Multivariable analysis was made to analyze the relationship between MHR and RA disease and features subclinical carotid atherosclerosis, and traditional CV factors including insulin resistance and beta cell function indices. MHR values did not differ between controls and patients after multivariable adjustment (12 ± 6 vs. 11 ± 6, p = 0.18). No relationship between this ratio and the characteristics of the disease was found excluding ESR, which showed a significant and positive association with MHR after adjustment for covariates. MHR significantly correlated with Systematic Coronary Risk Evaluation-2 (SCORE2) cardiovascular risk algorithm, and insulin resistance and beta cell function parameters after adjustment. In conclusion, MHR does not differ between patients with RA and controls. The relationship of this biomarker with disease-related data is poor. However, MHR is highly and positively related to cardiovascular risk and insulin resistance in RA.
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Affiliation(s)
- Alejandro Romo-Cordero
- Division of Internal Medicine, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (A.R.-C.); (C.M.-G.)
| | - Marta González-Sierra
- Division of Hospitalization-at-Home, Hospital Universitario de Canarias, 38320 Tenerife, Spain;
| | - Juan Carlos Quevedo-Abeledo
- Division of Rheumatology, Hospital Universitario Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain; (J.C.Q.-A.); (A.Q.-R.)
| | - Adrián Quevedo-Rodríguez
- Division of Rheumatology, Hospital Universitario Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain; (J.C.Q.-A.); (A.Q.-R.)
| | - Fuensanta Gómez-Bernal
- Division of Central Laboratory, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (F.G.-B.); (A.d.V.-G.)
| | - Antonia de Vera-González
- Division of Central Laboratory, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (F.G.-B.); (A.d.V.-G.)
| | - Raquel López-Mejías
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Instituto de Investigación Sanitaria Marqués de Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, 39011 Santander, Spain;
| | | | - Candelaria Martín-González
- Division of Internal Medicine, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (A.R.-C.); (C.M.-G.)
- Internal Medicine Department, Universidad de La Laguna, 38200 Tenerife, Spain
| | - Miguel Ángel González-Gay
- Department of Medicine and Psychiatry, Universidad de Cantabria, 39005 Santander, Spain
- Division of Rheumatology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Iván Ferraz-Amaro
- Internal Medicine Department, Universidad de La Laguna, 38200 Tenerife, Spain
- Division of Rheumatology, Hospital Universitario de Canarias, 38320 Tenerife, Spain
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6
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Almeida-Santiago C, Quevedo-Abeledo JC, Hernández-Hernández V, de Vera-González A, González-Delgado A, González-Gay MÁ, Ferraz-Amaro I. Circulating interleukin-6 and cardiovascular disease risk in patients with rheumatoid arthritis with low disease activity due to active therapy. Clin Exp Rheumatol 2023; 41:1537-1543. [PMID: 36719751 DOI: 10.55563/clinexprheumatol/mr4bka] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/11/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Interleukin-6 (IL-6) has been implicated in the pathophysiology of rheumatoid arthritis (RA) and in the development of atherosclerosis in the general population. In the present work we aimed to study if IL-6 serum levels have an influence on factors associated with cardiovascular (CV) disease in a cohort of Spanish patients with RA. METHODS Cross-sectional study that encompassed 407 patients with RA. Serum IL-6 levels were assessed. Multivariable analysis was performed to examine the relationship of IL-6 to subclinical carotid atherosclerosis and classic CV risk factors, including a comprehensive lipid molecule profile and indices of insulin resistance and beta-cell function. RESULTS Circulating levels of IL-6 showed a correlation with acute phase reactants, disease activity, and other features of RA. However, classic CV risk factors, lipid profile and indices of insulin resistance, as well as subclinical carotid atherosclerosis, were not associated with serum IL-6 levels. CONCLUSIONS Although a direct association between IL-6 levels and traditional CV risk factors and subclinical carotid atherosclerosis was not observed, circulating IL-6 was associated with disease activity and acute-phase reactants, which have been associated with an increased risk of CV in these patients.
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Affiliation(s)
| | | | | | | | | | - Miguel Ángel González-Gay
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
| | - Iván Ferraz-Amaro
- Servicio de Reumatología, Hospital Universitario de Canarias, Tenerife, and Departamento de Medicina Interna, Universidad de La Laguna, Tenerife, Spain.
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7
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González-Sierra M, Quevedo-Rodríguez A, Romo-Cordero A, González-Chretien G, Quevedo-Abeledo JC, de Vera-González A, González-Delgado A, Martín-González C, González-Gay MÁ, Ferraz-Amaro I. Relationship of Blood Inflammatory Composite Markers with Cardiovascular Risk Factors and Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis. Life (Basel) 2023; 13:1469. [PMID: 37511843 PMCID: PMC10381769 DOI: 10.3390/life13071469] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/14/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammatory index (SIRI, neutrophils × monocytes/lymphocytes) have been described as potential blood-derived inflammatory biomarkers in several diseases. Rheumatoid arthritis is an inflammatory disease that has been related to an increased risk of cardiovascular (CV) disease. In the present work, we analyze how these hematological composite scores of inflammation are related to classic CV risk factors and subclinical atherosclerosis in patients with RA. In this cross-sectional study that included 430 patients with RA, the NLR, MLR, PLR, and SIRI scores were calculated. Multivariable analysis was performed to examine the relationships of these composite blood scores with subclinical carotid atherosclerosis and with traditional cardiovascular factors, producing a complete profile of lipid molecules and insulin resistance or indices of beta-cell function, and a Systematic Coronary Risk Assessment (SCORE2) calculation. C-reactive protein and disease activity were significantly and positively associated with the four blood composite scores. SCORE2 was significantly associated with higher values of SIRI, NLR, and MLR, but not PLR. These relationships were maintained when SCORE 2 was considered categorical; patients in the very high CV risk category had higher values in all hematological composite scores, except PLR. In the multivariable analysis, SIRI and NLR were independently associated with higher levels of beta cell dysfunction. In conclusion, SCORE2 and the values of the hematological composite scores were positively correlated in patients with RA. In addition, there were some relationships of these scores with traditional CV risk factors, with their association with beta cell dysfunction being the most consistent.
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Affiliation(s)
- Marta González-Sierra
- Divsion of Hospitalization-at-Home, Hospital Universitario de Canarias, 38320 Tenerife, Spain
| | - Adrián Quevedo-Rodríguez
- Division of Rheumatology, Hospital Universitario Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain
| | - Alejandro Romo-Cordero
- Division of Internal Medicine, Hospital Universitario de Canarias, 38320 Tenerife, Spain
| | | | | | | | | | - Candelaria Martín-González
- Division of Internal Medicine, Hospital Universitario de Canarias, 38320 Tenerife, Spain
- Internal Medicine Department, Universidad de La Laguna, 38200 Tenerife, Spain
| | - Miguel Ángel González-Gay
- Division of Rheumatology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Cantabria, 39005 Santander, Spain
| | - Iván Ferraz-Amaro
- Internal Medicine Department, Universidad de La Laguna, 38200 Tenerife, Spain
- Division of Rheumatology, Hospital Universitario de Canarias, 38320 Tenerife, Spain
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8
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Gómez-Bernal F, Quevedo-Abeledo JC, García-González M, Fernández-Cladera Y, González-Rivero AF, Martín-González C, González-Gay MÁ, Ferraz-Amaro I. Transforming growth factor beta 1 is associated with subclinical carotid atherosclerosis in patients with systemic lupus erythematosus. Arthritis Res Ther 2023; 25:64. [PMID: 37069672 PMCID: PMC10108540 DOI: 10.1186/s13075-023-03046-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/05/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Transforming growth factor beta (TGF-β1) is a multifunctional cytokine that has anti-inflammatory and immunosuppressive effects. TGF-β1 has been linked to cardiovascular disease in the general population. The immunosuppressive effect of TGF-β1 is believed to be dysregulated in patients with systemic lupus erythematosus (SLE). In the present work, we aimed to study the relationship of serum levels of TGF-β1 with subclinical carotid atherosclerosis in patients with SLE. METHODS The study included 284 patients with SLE. Serum levels of TGF-β1 and subclinical carotid atherosclerosis (by carotid ultrasonography) were evaluated. In addition, the complete lipid profile and insulin resistance were analyzed. Multivariable linear and logistic regression analysis was performed to establish the relationship of TGF-β1 with carotid subclinical atherosclerosis adjusting for traditional cardiovascular risk factors that included lipid profile and insulin resistance. RESULTS Circulating TGF-β1 was positively and significantly associated with higher levels of LDL:HDL cholesterol ratio and atherogenic index. TGF-β1 was also associated with significantly lower levels of HDL cholesterol and apolipoprotein A1. Remarkably, TGF-β1 was associated with the presence of carotid plaque not only after adjustment for demographics (age, sex, body mass index, diabetes, hypertension, and aspirin use) but also after adjustment for relationships of TGF-β1 with lipid profile molecules, insulin resistance, and SLEDAI disease score (odds ratio 1.14 [95% confidence interval 1.003-1.30], p = 0.045). CONCLUSION TGF-β1 serum levels are positively and independently associated with the presence of subclinical atherosclerosis disease in patients with SLE.
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Affiliation(s)
| | | | | | | | | | - Candelaria Martín-González
- Division of Internal Medicine, Hospital Universitario de Canarias, Tenerife, Spain
- Department of Internal Medicine, University of La Laguna (ULL), Tenerife, Spain
| | - Miguel Á. González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group On Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Rheumatology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain
- Department of Internal Medicine, University of La Laguna (ULL), Tenerife, Spain
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9
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Ferraz-Amaro I, Genre F, Blanco R, Corrales A, Mazón IG, Portilla V, Aurrecoechea E, Mata C, Hernández-Hernández V, Quevedo-Abeledo JC, Rodríguez-Lozano C, Lopez-Medina C, Ladehesa-Pineda ML, Castañeda S, Vicente EF, Fernández-Carballido C, Martínez-Vidal MP, Castro-Corredor D, Anino-Fernández J, Peiteado D, Plasencia-Rodríguez C, Vivar MLG, Galíndez-Agirregoikoa E, Vegas-Revenga N, Urionagüena-Onaindia I, Perez EM, Díaz CF, González-Gay MÁ, Rueda-Gotor J. Sex differences in cardiovascular and disease-related features in axial spondyloarthritis. A multicenter study of 912 patients. Semin Arthritis Rheum 2023; 60:152198. [PMID: 37058848 DOI: 10.1016/j.semarthrit.2023.152198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/09/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVES To determine the potential impact of sex-specific disease-related characteristics on cardiovascular (CV) disease in axial spondyloarthritis (axSpA). METHODS Cross-sectional study of the Spanish AtheSpAin cohort to study CV disease in axSpA. Data on carotid ultrasound and CV disease and disease-related features were collected. RESULTS 611 men and 301 women were recruited. Classic CV risk factors were significantly less prevalent in women, who also showed a lower frequency of carotid plaques (p = 0.001), lower carotid intima-media thickness (IMT) values (p<0.001) and CV events (p = 0.008). However, after adjustment for classic CV risk factors, only the differences with respect to carotid IMT remained statistically significant. Women showed higher ESR at diagnosis (p = 0.038), and more active disease (ASDAS, p = 0.012, and BASDAI, p<0.001). They had shorter disease duration (p<0.001), lower prevalence of psoriasis (p = 0.008), less structural damage (mSASSS, p<0.001), and less mobility limitation (BASMI, p = 0.033). To establish whether these findings could lead to sex differences in CV disease burden, we compared the prevalence of carotid plaques in men and women with the same level of CV risk stratified according to the Systematic Coronary Risk Evaluation (SCORE). Men included in the low-moderate CV risk SCORE category had more carotid plaques (p = 0.050), along with longer disease duration (p = 0.004), higher mSASSS (p = 0.001) and psoriasis (p = 0.023). In contrast, in the high-very high-risk SCORE category, carotid plaques were observed more frequently in women (p = 0.028), who were characterized as having worse BASFI (p = 0.011), BASDAI (p<0.001) and ASDAS (p = 0.027). CONCLUSION Disease-related features may influence the expression of atherosclerosis in patients with axSpA. This may be especially applicable to women at high CV risk, characterized by greater disease severity and more severe subclinical atherosclerosis than men, suggesting a stronger interaction between disease activity and atherosclerosis in women with axSpA.
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Affiliation(s)
- Iván Ferraz-Amaro
- Rheumatology Division, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Fernanda Genre
- IDIVAL, Research group on genetic epidemiology and atherosclerosis in systemic diseases and inmetabolic bone diseases of the musculoskeletal system, Santander, Spain
| | - Ricardo Blanco
- IDIVAL, Research group on genetic epidemiology and atherosclerosis in systemic diseases and inmetabolic bone diseases of the musculoskeletal system, Santander, Spain; Rheumatology Division, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Alfonso Corrales
- IDIVAL, Research group on genetic epidemiology and atherosclerosis in systemic diseases and inmetabolic bone diseases of the musculoskeletal system, Santander, Spain; Rheumatology Division, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Iñigo González Mazón
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Virginia Portilla
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Cristina Mata
- Rheumatology Division, Hospital Comarcal de Laredo, Laredo, Spain
| | | | | | - Carlos Rodríguez-Lozano
- Rheumatology Division, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | - Santos Castañeda
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Esther F Vicente
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | | | - M Paz Martínez-Vidal
- Rheumatology Division, Hospital General Universitario de Alicante, Alicante, Spain
| | - David Castro-Corredor
- Rheumatology Division, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Diana Peiteado
- Rheumatology Division, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | | | | | | | - Miguel Ángel González-Gay
- IDIVAL and Department of Medicine and Psychiatry, School of Medicine, Universidad de Cantabria, Santander, Spain; Rheumatology Division, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Javier Rueda-Gotor
- IDIVAL, Research group on genetic epidemiology and atherosclerosis in systemic diseases and inmetabolic bone diseases of the musculoskeletal system, Santander, Spain; Rheumatology Division, Hospital Sierrallana, Torrelavega, Spain.
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10
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Martín-González C, Gómez-Bernal F, Quevedo-Abeledo JC, Ferrer-Moure C, Espelosín-Ortega E, González-Gay MÁ, Ferraz-Amaro I. Alpha-Klotho protein in systemic lupus erythematosus. Clin Exp Rheumatol 2023; 41:41-47. [PMID: 35349421 DOI: 10.55563/clinexprheumatol/salqon] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/21/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Alpha-Klotho protein (α-Klotho) is an essential component of endocrine fibroblast growth factor receptor complexes that governs multiple metabolic processes including aging-related disorders, diabetes, cancer, arteriosclerosis, and chronic kidney disease. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect almost any organ in the body and in which multiple pathophysiological abnormalities are observed. In the present work, our objective was to study whether the serum levels of α-Klotho differ between patients with SLE and controls, and how this protein is related to the clinical and laboratory characteristics of the disease. METHODS Cross-sectional study that included 364 women, 195 of them diagnosed with SLE and 169 sex- and age-matched controls. Circulating α-Klotho was analysed in SLE patients and controls. A multivariable analysis was performed to assess whether α-Klotho differs between patients and controls, and to study its relationship with SLE features. RESULTS No differences were found in α-Klotho levels between SLE patients and controls, both in univariable and multivariable analyses. Disease-related data like SLE duration, acute phase reactants, activity, severity and damage indices, and autoantibodies profile were not significantly associated with serum levels of α-Klotho. However, the use of prednisone and the presence of musculoskeletal manifestations were significantly related to higher α-Klotho serum levels. CONCLUSIONS α-Klotho protein serum levels do not differ between patients with SLE and controls. Nevertheless, SLE patients taking prednisone or those with musculoskeletal manifestations show significantly higher circulating levels of α-Klotho.
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Affiliation(s)
- Candelaria Martín-González
- Division of Internal Medicine, Hospital Universitario de Canarias, Tenerife, and Department of Internal Medicine, University of La Laguna, Tenerife, Spain
| | | | | | - Carmen Ferrer-Moure
- Division of Central Laboratory, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Miguel Ángel González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain; and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Iván Ferraz-Amaro
- Department of Internal Medicine, University of La Laguna, Tenerife, and Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain.
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11
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Martín-González C, Martín-Folgueras T, Quevedo-Abeledo JC, de Armas-Rillo L, González-Gay MÁ, Ferraz-Amaro I. Disease activity in patients with rheumatoid arthritis increases serum levels of apolipoprotein C-III. Clin Exp Rheumatol 2023; 41:67-73. [PMID: 35383559 DOI: 10.55563/clinexprheumatol/fe4go6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/07/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) has been unequivocally associated with an increased burden of accelerated atherosclerosis, which, at least in part, is a consequence of the inflammation present in the disease. Apolipoprotein C-III (ApoC3) is a key molecule in triglycerides metabolism that has been linked to cardiovascular (CV) disease. Our objective was to study how ApoC3 is related to the characteristics of RA, paying special attention to its relationship with the inflammatory activity of the disease. METHODS Cross-sectional study that included 430 patients with RA. In these patients, data related to the disease, classic CV risk factors, complete lipid profile, and serum ApoC3 levels were evaluated. A multivariable regression analysis was performed to study the relationship of the characteristics of RA with ApoC3. RESULTS Abdominal circumference, obesity, type 2 diabetes, and circulating triglycerides were significantly associated with higher ApoC3 serum levels. Furthermore, C-reactive protein and erythrocyte sedimentation rate, as well as the disease activity score -DAS28- were significantly related to a higher circulating ApoC3 after multivariable analysis. Patients included in the moderate or high disease activity groups had higher ApoC3 serum levels compared to those in remission (beta coefficient 1.28 [95% confidence interval 0.16-2.39] mg/dl, p=0.025) when adjusting for confounders. The use of prednisone, disease-modifying anti-rheumatic drugs and anti-tumour necrosis factor therapies was associated with lower values of ApoC3. CONCLUSIONS The activity of the disease in patients with RA is independently associated with higher serum levels of ApoC3.
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Affiliation(s)
- Candelaria Martín-González
- Division of Internal Medicine, Hospital Universitario de Canarias, Tenerife, and Department of Internal Medicine, University of La Laguna (ULL), Tenerife, Spain
| | | | | | | | - Miguel Ángel González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain; and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Iván Ferraz-Amaro
- Department of Internal Medicine, University of La Laguna (ULL), Tenerife, and Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain.
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12
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Gómez-Bernal F, Quevedo-Abeledo JC, García-González M, Fernández-Cladera Y, González-Rivero AF, de Vera-González A, Martín-González C, González-Gay MÁ, Ferraz-Amaro I. Serum Levels of Transforming Growth Factor Beta 1 in Systemic Lupus Erythematosus Patients. Biomolecules 2022; 13:biom13010073. [PMID: 36671458 PMCID: PMC9855909 DOI: 10.3390/biom13010073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Transforming growth factor beta (TGF-β) is a highly pleiotropic cytokine that has broad anti-inflammatory and immunosuppressive effects. In patients with systemic lupus erythematosus (SLE), the immunosuppressive effect of TGF-β1 is thought to be dysfunctional. In the present work, we aimed to study the relationship between the serum levels of TGF-β1 with the characteristics of the disease as well as with the patterns of activity, damage, or severity of the disease. Two hundred and eighty-four patients with well-characterized SLE were recruited. The serum levels of TGF-β1 were assessed. A multivariable linear regression analysis was performed to analyze the relation of disease characteristics to TGF-β1. The Katz severity index (beta coefficient 179 [95% confidence interval 7-350] pg/mL, p = 0.041) and SLEDAI activity index (beta coefficient 96 [95% CI 20-171] pg/mL, p = 0.014) were associated with higher serum levels of TGF-β1 after the multivariable analysis. When the disease-specific features were studied, ocular and cardiovascular manifestations were positively associated with serum TGF-β1 levels. In contrast, gastrointestinal and musculoskeletal involvements were associated with lower levels of circulating TGF-β1. Among patients with SLE, the serum levels of TGF-β1 were highly associated with disease-related manifestations.
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Affiliation(s)
- Fuensanta Gómez-Bernal
- Division of Central Laboratory, Hospital Universitario de Canarias, 38320 Tenerife, Spain
| | | | | | | | | | | | - Candelaria Martín-González
- Division of Internal Medicine, Hospital Universitario de Canarias, 38320 Tenerife, Spain
- Department of Internal Medicine, University of La Laguna (ULL), 38200 Tenerife, Spain
| | - Miguel Á. González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, 39011 Santander, Spain
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39011 Santander, Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- Correspondence: (M.Á.G.-G.); (I.F.-A.)
| | - Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, 38320 Tenerife, Spain
- Department of Internal Medicine, University of La Laguna (ULL), 38200 Tenerife, Spain
- Correspondence: (M.Á.G.-G.); (I.F.-A.)
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13
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Almeida-Santiago C, Quevedo-Abeledo JC, Hernández-Hernández MV, de Vera-González A, González-Delgado A, González-Gay MÁ, Ferraz-Amaro I. Disease Activity Is More Associated with IL-1 Than with IL-6 in Patients with Rheumatoid Arthritis. Life (Basel) 2022; 13:life13010082. [PMID: 36676031 PMCID: PMC9862960 DOI: 10.3390/life13010082] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/16/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
Interleukin-1 receptor antagonist (IL-1ra) concentration reflects and is proportional to IL-1 production. Both IL-1 and IL-6 are involved in the pathogenesis of rheumatoid arthritis (RA). However, the relationship of serum levels of these two cytokines to each other in RA patients is not well-understood. In this study, our objective was to analyze the possible linear correlation between IL-1ra and IL-6 in patients with RA, and how both are related to the inflammatory activity of the disease. IL-6 and IL-1ra levels were measured in 407 patients with RA. Linear regression and partial correlations were conducted to analyze the relationship between both cytokines, and their association with RA characteristics. No correlation was found between serum levels of IL-6 and IL-1ra (Pearson's r 0.031, p = 0.61). However, disease activity and acute phase reactants were positively and significantly associated with both cytokines. Nevertheless, after controlling for covariates, disease activity scores were more strongly associated with IL-1ra compared to IL-6. Circulating IL-6 and IL-1ra do not correlate with each other in RA patients. Although both are associated with disease activity and acute phase reactants, the relationship of disease activity to IL-1ra is greater than that to IL-6.
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Affiliation(s)
- Cristina Almeida-Santiago
- Servicio de Reumatología, Hospital Universitario Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain
| | | | | | | | | | - Miguel Ángel González-Gay
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39011 Santander, Spain
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, 39011 Santander, Spain
- Correspondence: (M.Á.G.-G.); (I.F.-A.)
| | - Iván Ferraz-Amaro
- Servicio de Reumatología, Hospital Universitario de Canarias, 38320 Tenerife, Spain
- Departamento de Medicina Interna, Universidad de La Laguna, 38200 Tenerife, Spain
- Correspondence: (M.Á.G.-G.); (I.F.-A.)
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14
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Gómez-Bernal F, Fernández-Cladera Y, Quevedo-Abeledo JC, García-González M, González-Rivero AF, de Vera-González A, Martín-González C, González-Gay MÁ, Ferraz-Amaro I. Vascular Endothelial Growth Factor and Its Soluble Receptor in Systemic Lupus Erythematosus Patients. Biomolecules 2022; 12:biom12121884. [PMID: 36551311 PMCID: PMC9775345 DOI: 10.3390/biom12121884] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Vascular endothelial growth factor (VEGF) is a major regulator of physiological and pathological angiogenesis. Its soluble receptor (sVEGFR) is a potent VEGF antagonist. Systemic lupus erythematosus (SLE) is an autoimmune disease with a diverse array of clinical manifestations that affect virtually any organ. We aimed to analyze the relationship of VEGF and sVEGFR with SLE disease-related features including disease activity, damage, and severity. Serum levels of VEGF165 isoform and sVEGFR (receptor 1) were assessed in 284 well-characterized patients with SLE. Linear regression analysis was performed to analyze the relationship of disease characteristics with both VEGF and sVEGFR. Patients with a disease damage index (SLICC score) equal to or greater than 1 had significantly elevated serum levels of VEGF and sVEGFR. Regarding disease-specific features, musculoskeletal manifestations were the disease feature most commonly associated with the upregulation of both VEGF and sVEGFR. SLE disease damage is associated with higher levels of VEGF and sVEGFR.
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Affiliation(s)
- Fuensanta Gómez-Bernal
- Division of Central Laboratory, Hospital Universitario de Canarias, 38320 Tenerife, Spain
| | | | | | | | | | | | - Candelaria Martín-González
- Division of Internal Medicine, Hospital Universitario de Canarias, 38320 Tenerife, Spain
- Department of Internal Medicine, University of La Laguna (ULL), 38200 Tenerife, Spain
| | - Miguel Á. González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, 39011 Santander, Spain
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39011 Santander, Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- Correspondence: (M.Á.G.-G.); (I.F.-A.)
| | - Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, 38320 Tenerife, Spain
- Department of Internal Medicine, University of La Laguna (ULL), 38200 Tenerife, Spain
- Correspondence: (M.Á.G.-G.); (I.F.-A.)
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15
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Rueda-Gotor J, Ferraz-Amaro I, Genre F, González Mazón I, Corrales A, Portilla V, Llorca J, Agudo-Bilbao M, Aurrecoechea E, Expósito R, Hernández-Hernández V, Quevedo-Abeledo JC, Rodríguez-Lozano C, Lopez-Medina C, Ladehesa-Pineda ML, Castañeda S, Vicente EF, Fernández-Carballido C, Martínez-Vidal MP, Castro-Corredor D, Anino-Fernández J, Peiteado D, Plasencia-Rodríguez C, Vivar MLG, Galíndez-Agirregoikoa E, Perez EM, Fernández Díaz C, Blanco R, González-Gay MÁ. Cardiovascular and disease-related features associated with extra-articular manifestations in axial spondyloarthritis. A multicenter study of 888 patients. Semin Arthritis Rheum 2022; 57:152096. [PMID: 36150319 DOI: 10.1016/j.semarthrit.2022.152096] [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] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/07/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To determine the potential impact of extra-articular manifestations (EAMs) on disease characteristics and cardiovascular (CV) risk in patients with axial spondylarthritis (axSpA). METHODS This is a cross-sectional study from the AtheSpAin cohort, a Spanish multicenter cohort to study atherosclerosis in axSpA. Data on the history of CV events, subclinical carotid atherosclerosis, and disease-related features, including EAMs, were collected. RESULTS 888 axSpA patients were recruited. Concomitant acute anterior uveitis (AAU), psoriasis (PSO), and inflammatory bowel disease (IBD) were present in 177 (19.9%), 96 (10.8%), and 57 (6.4%) patients, respectively. When compared with axSpA patients without EAMs, a significant increase in past CV events was observed in patients with PSO (9% versus 4%, p = 0.048) and in those with at least one EAM (7% versus 4%, p = 0.032) or with more than one EAM (11% versus 4%, p = 0.022). The frequency of carotid plaques and the values of cIMT were higher in patients with EAMs than in those without EAMs, although only the univariable analysis for carotid plaques in patients with PSO (39% versus 30%, p = 0.038) and for cIMT in patients with AAU (665 ± 156 µm versus 637 ± 139 µm, p = 0.042) and those with at least one EAM (661 ± 155 µm versus 637 ± 139 µm, p = 0.024) showed significant results. In addition, patients with PSO or IBD were found to have specific disease-related features, such as higher ESR at diagnosis, and more frequent use of glucocorticoids and TNF inhibitors than those without EAMs. Also, PSO patients had more commonly peripheral involvement and those with AAU more severe radiographic damage than those without EAMs. The frequency of HLA B27 was higher in patients with AAU and lower in those with PSO or IBD compared to those without EAMs. CONCLUSION Patients with axSpA and EAMs, in addition to displaying their own disease-related features, are likely to have an increased CV risk that appears proportional to the number of EAMs and could be related to proatherogenic factors other than traditional CV risk factors, such as the inflammatory load and the use of glucocorticoids.
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Affiliation(s)
- Javier Rueda-Gotor
- Rheumatology Division, Hospital Sierrallana, Torrelavega, Spain; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, Santander, Spain.
| | - Iván Ferraz-Amaro
- Rheumatology Division, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Fernanda Genre
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, Santander, Spain
| | - Iñigo González Mazón
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Alfonso Corrales
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, Santander, Spain; Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Virginia Portilla
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Javier Llorca
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain
| | | | | | - Rosa Expósito
- Division of Rheumatology, Hospital Comarcal, Laredo, Cantabria, Spain
| | | | | | - Carlos Rodríguez-Lozano
- Rheumatology Division, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | - Santos Castañeda
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Esther F Vicente
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | | | - M Paz Martínez-Vidal
- Rheumatology Division, Hospital General Universitario de Alicante, Alicante, Spain
| | - David Castro-Corredor
- Rheumatology Division, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | | | | | | | | | - Ricardo Blanco
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, Santander, Spain; Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Miguel Ángel González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, Santander, Spain; Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain; School of Medicine, University of Cantabria, Santander, Spain; University of the Witwatersrand, Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, South Africa
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16
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Remuzgo-Martínez S, Rueda-Gotor J, Pulito-Cueto V, López-Mejías R, Corrales A, Lera-Gómez L, Pérez-Fernández R, Portilla V, González-Mazón Í, Blanco R, Expósito R, Mata C, Llorca J, Hernández-Hernández V, Rodríguez-Lozano C, Barbarroja N, Ortega-Castro R, Vicente E, Fernández-Carballido C, Martínez-Vidal MP, Castro-Corredor D, Anino-Fernández J, Peiteado D, Plasencia-Rodríguez C, Galíndez-Agirregoikoa E, García-Vivar ML, Vegas-Revenga N, Urionaguena I, Gualillo O, Quevedo-Abeledo JC, Castañeda S, Ferraz-Amaro I, González-Gay MÁ, Genre F. Irisin as a Novel Biomarker of Subclinical Atherosclerosis, Cardiovascular Risk and Severe Disease in Axial Spondyloarthritis. Front Immunol 2022; 13:894171. [PMID: 35898516 PMCID: PMC9309281 DOI: 10.3389/fimmu.2022.894171] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/08/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Patients with axial spondyloarthritis (axSpA) have a high disease burden mainly due to the rheumatic disease itself, and also exhibit accelerated atherosclerosis, that leads to a higher incidence of cardiovascular (CV) disease. Accordingly, the identification of biomarkers of CV risk and inflammation in axSpA patients is clinically relevant. In this sense, given the beneficial functions exerted by the adipomyokine irisin in processes related to CV disease and inflammation, our aim was to assess, for the first time, the role of irisin as a genetic and serological biomarker of subclinical atherosclerosis, CV risk and disease severity in axSpA patients. Methods A large cohort of 725 Spanish patients with axSpA was included. Subclinical atherosclerosis (presence of plaques and abnormal carotid intima-media thickness values) was evaluated by carotid ultrasound. Four irisin polymorphisms (rs16835198 G/T, rs3480 A/G, rs726344 G/A, and rs1570569 G/T) were genotyped by TaqMan probes. Additionally, serum irisin levels were determined by ELISA. Results Low irisin levels were linked to the presence of plaques (p=0.002) and atherogenic index values ≥4 (p=0.01). Serum irisin were positively correlated with C-peptide levels (p<0.001) and negatively correlated with visual analogue scale and Bath Ankylosing Spondylitis Metrology Index (p<0.05 in all the cases). Moreover, lower irisin levels were observed in patients with sacroiliitis and in those with a negative HLA-B27 status (p<0.001 and p=0.006, respectively), as well as in those treated with non-steroidal anti-inflammatory drugs and conventional disease-modifying antirheumatic drugs (p<0.001 and p=0.002, respectively). Interestingly, the TT genotype and the T allele of rs16835198 were less frequent in axSpA patients with ASDAS >2.1 (Odds Ratio (OR): 0.48 [0.28-0.83] and OR: 0.73 [0.57-0.92], respectively, p=0.01 in both cases). Additionally, the frequency of rs1570569 T allele was higher in these patients (OR: 1.46 [1.08-1.97], p=0.01). Furthermore, the GGGT haplotype was more frequent in patients with ASDAS values >2.1 (OR: 1.73 [1.13-2.66], p=0.01). Conclusions Our results indicate that low serum irisin levels could be indicators of the presence of subclinical atherosclerosis, high CV risk and more severe disease in axSpA patients. In addition, irisin may also constitute a genetic biomarker of disease activity in axSpA.
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Affiliation(s)
- Sara Remuzgo-Martínez
- Research group on genetic epidemiology and atherosclerosis in systemic diseases and in metabolic diseases of the musculoskeletal system, Instituto de Investigación Sanitaria IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Javier Rueda-Gotor
- Research group on genetic epidemiology and atherosclerosis in systemic diseases and in metabolic diseases of the musculoskeletal system, Instituto de Investigación Sanitaria IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Verónica Pulito-Cueto
- Research group on genetic epidemiology and atherosclerosis in systemic diseases and in metabolic diseases of the musculoskeletal system, Instituto de Investigación Sanitaria IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Raquel López-Mejías
- Research group on genetic epidemiology and atherosclerosis in systemic diseases and in metabolic diseases of the musculoskeletal system, Instituto de Investigación Sanitaria IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Alfonso Corrales
- Research group on genetic epidemiology and atherosclerosis in systemic diseases and in metabolic diseases of the musculoskeletal system, Instituto de Investigación Sanitaria IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Leticia Lera-Gómez
- Research group on genetic epidemiology and atherosclerosis in systemic diseases and in metabolic diseases of the musculoskeletal system, Instituto de Investigación Sanitaria IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Raquel Pérez-Fernández
- Research group on genetic epidemiology and atherosclerosis in systemic diseases and in metabolic diseases of the musculoskeletal system, Instituto de Investigación Sanitaria IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Virginia Portilla
- Research group on genetic epidemiology and atherosclerosis in systemic diseases and in metabolic diseases of the musculoskeletal system, Instituto de Investigación Sanitaria IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Íñigo González-Mazón
- Research group on genetic epidemiology and atherosclerosis in systemic diseases and in metabolic diseases of the musculoskeletal system, Instituto de Investigación Sanitaria IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ricardo Blanco
- Research group on genetic epidemiology and atherosclerosis in systemic diseases and in metabolic diseases of the musculoskeletal system, Instituto de Investigación Sanitaria IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Rosa Expósito
- Rheumatology Division, Hospital Comarcal de Laredo, Laredo, Spain
| | - Cristina Mata
- Rheumatology Division, Hospital Comarcal de Laredo, Laredo, Spain
| | - Javier Llorca
- Department of Epidemiology and Computational Biology, School of Medicine, Universidad de Cantabria, Santander, Spain
- Consorcio Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Santander, Spain
| | | | - Carlos Rodríguez-Lozano
- Rheumatology Division, Hospital Universitario de Gran Canaria Dr. Negŕın, Las Palmas de Gran Canaria, Spain
| | - Nuria Barbarroja
- Rheumatology Division, Hospital Reina Sofía, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | - Rafaela Ortega-Castro
- Rheumatology Division, Hospital Reina Sofía, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | - Esther Vicente
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | | | | | - David Castro-Corredor
- Rheumatology Division, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Diana Peiteado
- Rheumatology Division, Hospital Universitario La Paz-IdiPaz, Madrid, Spain
| | | | | | | | | | | | - Oreste Gualillo
- Servicio Gallego de Salud (SERGAS) and Instituto para el Desarrollo e Integración de la Sanidad (IDIS), Neuroendocrine Interactions in Rheumatic and Inflammatory Diseases (NEIRID) Lab, Research Laboratory 9, Hospital Cl´ınico Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Santos Castañeda
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Iván Ferraz-Amaro
- Rheumatology Division, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Miguel Á. González-Gay
- Research group on genetic epidemiology and atherosclerosis in systemic diseases and in metabolic diseases of the musculoskeletal system, Instituto de Investigación Sanitaria IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Medicine and Psychiatry Department, Universidad de Cantabria, Santander, Spain
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fernanda Genre
- Research group on genetic epidemiology and atherosclerosis in systemic diseases and in metabolic diseases of the musculoskeletal system, Instituto de Investigación Sanitaria IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- *Correspondence: Fernanda Genre,
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Martín-González C, Martín-Folgueras T, Quevedo-Abeledo JC, de Vera-González A, González-Delgado A, de Armas-Rillo L, González-Gay MÁ, Ferraz-Amaro I. Apolipoprotein C-III is linked to the insulin resistance and beta-cell dysfunction that are present in rheumatoid arthritis. Arthritis Res Ther 2022; 24:126. [PMID: 35637531 PMCID: PMC9150381 DOI: 10.1186/s13075-022-02822-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/06/2021] [Accepted: 05/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background Insulin resistance and beta-cell dysfunction are manifestations of rheumatoid arthritis (RA). Apolipoprotein C-III (ApoC3) has been associated with such insulin resistance and beta-cell dysfunction in the general population. Our purpose was to study whether ApoC3 is also related to the insulin resistance and beta-cell dysfunction that are present in patients with RA. Methods Three hundred thirty-eight non-diabetic patients with RA who had a glycemia lower than 110 mg/dl were recruited. Insulin, C-peptide, and ApoC3 were assessed. Insulin resistance and beta-cell function were calculated using the Homeostasis Model Assessment (HOMA2) indices. A multivariable regression analysis was performed to study the relationship of ApoC3 with those molecules and indices adjusting for classic factors associated with insulin resistance that included glucocorticoids. Results ApoC3 was related to significant higher levels of circulating insulin (beta coef. 0.37 [95%CI 0.01–0.73] µU/ml, p = 0.044) and C-peptide (beta coef. 0.13 [95%CI 0.05–0.22] ng/ml, p = 0.003), and higher insulin resistance —HOMA2-IR— (beta coef. 0.05 [95%CI 0.00–0.09], p = 0.041) and beta-cell dysfunction —HOMA2-%B— (beta coef. 2.94 [95%CI 0.07–5.80], p = 0.044) indices. This was found after a fully multivariable analysis that included, among others, prednisone intake and the classic factors associated with carbohydrate metabolism such as triglycerides, waist circumference, and obesity. Conclusion ApoC3, insulin resistance, and beta-cell dysfunction are independently associated in patients RA.
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Affiliation(s)
- Candelaria Martín-González
- Division of Internal Medicine, Hospital Universitario de Canarias, Tenerife, Spain.,Department of Internal Medicine, University of La Laguna (ULL), Tenerife, Spain
| | | | | | | | | | | | - Miguel Á González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group On Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain. .,Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain. .,Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Iván Ferraz-Amaro
- Department of Internal Medicine, University of La Laguna (ULL), Tenerife, Spain. .,Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain.
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Martín-González C, Ferrer-Moure C, Carlos Quevedo-Abeledo J, de Vera-González A, González-Delgado A, Sánchez-Martín J, González-Gay MÁ, Ferraz-Amaro I. Apolipoprotein C-III in patients with systemic lupus erythematosus. Arthritis Res Ther 2022; 24:104. [PMID: 35538496 PMCID: PMC9088095 DOI: 10.1186/s13075-022-02793-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) has been associated with atherosclerotic cardiovascular disease (CV) and an altered lipid profile. High levels of apolipoprotein C-III (ApoC3) are associated with elevated triglyceride levels and an increased risk of CV. In the present study, we aimed to study circulating ApoC3 in patients with SLE and describe its relationship with the manifestations of the disease. METHODS This is a cross-sectional study that included 186 patients with SLE. Disease-related data, CV comorbidity, full lipid profile, and serum levels of ApoC3 were assessed. A multivariable regression analysis was performed to study how ApoC3 was related to SLE features. RESULTS Classic CV risk factors were significantly and strongly associated with circulating ApoC3. After a fully multivariable analysis that included classic CV risk factors and lipid profile molecules, SLICC damage (beta coef. 0.10 [95% CI 0.02-0.19] mg/dl, 0.020) and Katz severity (beta coef. 0.11 [95% CI 0.03-0.19] mg/dl, p = 0.011) indices and SLEDAI activity score (beta coef. 0.05 [95% CI 0.05-0.08] mg/dl, p = 0.004) were all independently associated with higher levels of circulating ApoC3. CONCLUSION Among SLE patients, disease activity, severity, and disease damage are independently associated with higher ApoC3 serum levels.
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Affiliation(s)
| | - Carmen Ferrer-Moure
- Division of Central Laboratory, Hospital Universitario de Canarias, Tenerife, Spain
| | | | | | | | - Julio Sánchez-Martín
- Epidemiology, Genetics and Atherosclerosis Research Group On Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Miguel Á González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group On Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain. .,Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain. .,Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain.
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Quevedo-Abeledo JC, Martín-González C, Ferrer-Moure C, de Armas-Rillo L, Hernandez-Hernandez MV, González-Gay MÁ, Ferraz-Amaro I. Key Molecules of Triglycerides Pathway Metabolism Are Disturbed in Patients With Systemic Lupus Erythematosus. Front Immunol 2022; 13:827355. [PMID: 35615358 PMCID: PMC9124762 DOI: 10.3389/fimmu.2022.827355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/13/2022] [Indexed: 11/22/2022] Open
Abstract
Background Elevated triglycerides or triglyceride-rich lipoproteins are an additional cause of cardiovascular (CV) disease. Given that patients with systemic lupus erythematosus (SLE) have a high prevalence of premature CV disease and show an altered lipid profile, our objective was to study whether three molecules that play a central role in the triglyceride metabolism: apolipoprotein C-III (ApoC3), angiopoietin-like protein 4 (ANGPLT4), and lipoprotein lipase (LPL) differ between SLE patients and controls, and how they are related to disease characteristics, including disease damage. Methods Cross-sectional study that included 347 women, 185 of them diagnosed with SLE and 162 age-matched controls. ANGPTL4, ApoC3 and LPL, and standard lipid profiles were analyzed in SLE patients and controls. A multivariable analysis was performed to assess whether ANGPTL4, ApoC3 and LPL molecules differ between patients and controls and to study their relationship with SLE disease damage. Results After fully multivariable analysis that included classic CV risk factors, and the modifications that the disease itself produces over the lipid profile, it was found that ApoC3 was significantly lower (beta coef. -1.2 [95%CI -1.6- -0.8) mg/dl, <0.001), and ANGPTL4 (beta coef. 63 [95%CI 35-90] ng/ml, <0.001) and LPL (beta coef. 79 [95%CI 30-128] ng/ml, p=0.002) significantly higher in patients with SLE compared to controls. Disease damage score was significantly and independently associated with higher serum levels of LPL (beta coef. 23 [95%CI 10-35] ng/ml, p=0.001). Mediation analysis suggested that the relationship between disease damage and LPL was direct and not mediated by ApoC3 or ANGPLT4. Conclusion The ApoC3, ANGPLT4 and LPL axis is disrupted in patients with SLE. Disease damage explains this disturbance.
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Affiliation(s)
| | - Candelaria Martín-González
- Division of Internal Medicine, Hospital Universitario de Canarias, Tenerife, Spain
- Internal Medicine Department, University of La Laguna, Tenerife, Spain
| | - Carmen Ferrer-Moure
- Division of Central Laboratory, Hospital Universitario de Canarias, Tenerife, Spain
| | | | | | - Miguel Á. González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, Faculty of Health Sciences, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
- *Correspondence: Iván Ferraz-Amaro, ; Miguel Á. González-Gay,
| | - Iván Ferraz-Amaro
- Internal Medicine Department, University of La Laguna, Tenerife, Spain
- Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain
- *Correspondence: Iván Ferraz-Amaro, ; Miguel Á. González-Gay,
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Rueda-Gotor J, Ferraz-Amaro I, Genre F, González-Mazón I, Corrales A, Calvo-Rio V, Portilla V, Llorca J, Expósito R, Hernández-Hernández V, Quevedo-Abeledo JC, Rodríguez-Lozano C, Lopez-Medina C, Ladehesa-Pineda ML, Castañeda S, Vicente EF, Fernández-Carballido C, Martínez-Vidal MP, Castro-Corredor D, Anino-Fernández J, Peiteado D, Plasencia-Rodríguez C, García-Vivar ML, Galíndez-Agirregoikoa E, Montes-Perez E, Fernández-Díaz C, Blanco R, González-Gay MÁ. Factors associated with atherosclerosis in radiographic and non-radiographic axial spondyloarthritis. A multicenter study on 838 patients. Semin Arthritis Rheum 2022; 55:152037. [DOI: 10.1016/j.semarthrit.2022.152037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/01/2022] [Accepted: 05/24/2022] [Indexed: 12/24/2022]
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de Armas-Rillo L, Quevedo-Abeledo JC, Hernández-Hernández V, de Vera-González A, González-Delgado A, García-Dopico JA, González-Gay MÁ, Ferraz-Amaro I. The angiopoietin-like protein 4, apolipoprotein C3, and lipoprotein lipase axis is disrupted in patients with rheumatoid arthritis. Arthritis Res Ther 2022; 24:99. [PMID: 35488290 PMCID: PMC9052638 DOI: 10.1186/s13075-022-02784-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 07/19/2021] [Accepted: 04/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background Modulators of triglyceride metabolism include lipoprotein lipase (LPL), angiopoietin-like protein 4 (ANGPTL4), and apolipoprotein C-3 (ApoC3). There is evidence on the influence of this triangle of molecules on an increased risk of atherosclerotic cardiovascular disease (CV) in the general population. Patients with rheumatoid arthritis (RA) present changes in lipid profiles and accelerated CV disease. In the present study, we set out to study whether the ANGPTL4, ApoC3, and LPL axis differs in subjects with RA compared to controls. In a further step, we investigated the relationship of this axis with subclinical atherosclerosis in patients with RA. Methods Cross-sectional study that included 569 individuals, 323 patients with RA and 246 age-matched controls. ANGPTL4, ApoC3 and LPL, and standard lipid profiles were analyzed in patients and controls. Carotid intima-media thickness (cIMT) and carotid plaques were assessed in RA patients. A multivariable analysis was performed to assess whether the ANGPTL4, ApoC3, and LPL axis was altered in RA and to study its relationship with RA dyslipidemia and subclinical carotid atherosclerosis. Results Most lipid profile molecules did not differ between patients and controls. Despite this, and after fully multivariable analysis including CV risk factors, use of statins, and changes in the lipid profile caused by the disease itself, patients with RA showed higher serum levels of ANGPTL4 (beta coef. 295 [95% CI 213–376] ng/ml, p<0.001) and ApoC3 (beta coef. 2.9 [95% CI 1.7–4.0] mg/dl, p<0.001), but lower circulating LPL (beta coef. −174 [95% CI −213 to −135] ng/ml, p<0.001). ANGPTL4 serum levels were positively and independently associated with a higher cIMT in patients with RA after fully multivariable adjustment. Conclusion The axis consisting in ANGPTL4, ApoC3, and LPL is disrupted in patients with RA. ANGPTL4 serum levels are positively and independently associated with a higher cIMT in RA patients.
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Affiliation(s)
| | | | | | | | | | - José A García-Dopico
- Division of Central Laboratory, Hospital Universitario de Canarias, Tenerife, Spain
| | - Miguel Á González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.,Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.,Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain.
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Quevedo-Abeledo JC, González-Gay MÁ, Ferraz-Amaro I. SCORE2 versus SCORE in patients with systemic lupus erythematosus. Ther Adv Musculoskelet Dis 2022; 14:1759720X221092373. [PMID: 35464811 PMCID: PMC9021470 DOI: 10.1177/1759720x221092373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Systemic lupus erythematosus (SLE) has been associated with an increased risk of cardiovascular (CV) disease. Recently, the Systematic Coronary Risk Assessment (SCORE), a well-known CV risk algorithm, has been updated to a new predictive model (SCORE2). This new algorithm improves the identification of individuals at high risk of developing CV disease across Europe. Since carotid atherosclerosis is a predictor of future CV events and CV death, our objective was to compare the predictive capacity of SCORE2 versus SCORE for the presence of subclinical carotid atherosclerosis in patients with SLE. Methods: Two hundred and thirty-five individuals over 40 years of age diagnosed with SLE were consecutively recruited in this cross-sectional study. SCORE and SCORE2 were calculated. The relationship of SCORE and SCORE2 with each other, and with the presence of subclinical carotid atherosclerosis (both carotid plaque and carotid intima media thickness -cIMT-), was studied. Results: SCORE2 and SCORE did not correlate with each other (Spearman’s Rho = 0.125, p = 0.065). Although SCORE did not correlate with cIMT (Spearman’s Rho = -0.022, p = 0.75), the correlation of SCORE2 with cIMT was statistically significant (Spearman’s Rho = 0.367, p < 0.001). Similarly, SCORE did not show significant discrimination for the presence of carotid plaque [AUC = 0.521 (95% CI = 0.443–0.600)], while SCORE2 did [AUC = 0.720 (95% CI = 0.656–0.785)]. The difference between AUCs was found to be statistically significant (p < 0.001), thus showing that the prediction capacity of SCORE2 was significantly higher than that of SCORE. Conclusion: In SLE patients, the ability of SCORE2 to predict the presence of subclinical atherosclerosis is higher than that of SCORE. According to our results, SCORE2, rather than SCORE, should be used in the CV risk stratification of patients with SLE. Prospective studies are needed to confirm these findings.
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Affiliation(s)
| | - Miguel Á. González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Cardenal Herrera Oria s/n, Santander 39008, Spain
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, Santa Cruz de Tenerife 38320, Spain
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Ferraz-Amaro I, Corrales A, Atienza-Mateo B, Vegas-Revenga N, Prieto-Peña D, Sánchez-Martín J, Almeida C, Quevedo-Abeledo JC, Blanco R, González-Gay MÁ. SCORE2 Assessment in the Calculation of Cardiovascular Risk in Patients with Rheumatoid Arthritis. Diagnostics (Basel) 2021; 11:diagnostics11122363. [PMID: 34943599 PMCID: PMC8700102 DOI: 10.3390/diagnostics11122363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Patients with rheumatoid arthritis (RA) are at increased risk for cardiovascular disease (CVD). Risk chart algorithms, such as the Systematic Coronary Risk Assessment (SCORE), often underestimate the risk of CVD in patients with RA. In this sense, the use of noninvasive tools, such as the carotid ultrasound, has made it possible to identify RA patients at high risk of CVD who had subclinical atherosclerosis disease and who had been included in the low or moderate CVD risk categories when the SCORE risk tables were applied. The 2003 SCORE calculator was recently updated to a new prediction model: SCORE2. This new algorithm improves the identification of individuals from the general population at high risk of developing CVD in Europe. Our objective was to compare the predictive capacity between the original SCORE and the new SCORE2 to identify RA patients with subclinical atherosclerosis and, consequently, high risk of CVD. 1168 non-diabetic patients with RA and age > 40 years were recruited. Subclinical atherosclerosis was searched for by carotid ultrasound. The presence of carotid plaque and the carotid intima media wall thickness (cIMT) were evaluated. SCORE and SCORE2 were also calculated. The relationships of SCORE and SCORE2 to each other and to the presence of subclinical carotid atherosclerosis were studied. The correlation between SCORE and SCORE2 was found to be high in patients with RA (Spearman’s Rho = 0.961, p < 0.001). Both SCORE (Spearman’s Rho = 0.524) and SCORE2 (Spearman’s Rho = 0.521) were similarly correlated with cIMT (p = 0.92). Likewise, both calculators showed significant and comparable discriminations for the presence of carotid plaque: SCORE AUC 0.781 (95%CI 0.755–0.807) and SCORE2 AUC 0.774 (95%CI 0.748–0.801). Using SCORE, 80% and 20% of the patients were in the low or moderate and high or very high CVD risk categories, respectively. However, when the same categories were evaluated using SCORE2, the percentages were different (58% and 42%, respectively). Consequently, the number of RA patients included in the high or very high CVD risk categories was significantly higher with SCORE2 compared to the original SCORE. (p < 0.001). In conclusion, although predictive capacity for the presence of carotid plaque is equivalent between SCORE and SCORE2, SCORE2 identifies a significantly higher proportion of patients with RA who are at high or very high risk of CVD.
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Affiliation(s)
- Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, 38320 Tenerife, Spain
- Internal Medicine Department, University of La Laguna, 38071 Tenerife, Spain
- Correspondence: (I.F.-A.); (M.Á.G.-G.)
| | - Alfonso Corrales
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39008 Santander, Spain; (A.C.); (B.A.-M.); (N.V.-R.); (D.P.-P.); (J.S.-M.); (R.B.)
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, 39011 Santander, Spain
| | - Belén Atienza-Mateo
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39008 Santander, Spain; (A.C.); (B.A.-M.); (N.V.-R.); (D.P.-P.); (J.S.-M.); (R.B.)
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, 39011 Santander, Spain
| | - Nuria Vegas-Revenga
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39008 Santander, Spain; (A.C.); (B.A.-M.); (N.V.-R.); (D.P.-P.); (J.S.-M.); (R.B.)
| | - Diana Prieto-Peña
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39008 Santander, Spain; (A.C.); (B.A.-M.); (N.V.-R.); (D.P.-P.); (J.S.-M.); (R.B.)
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, 39011 Santander, Spain
| | - Julio Sánchez-Martín
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39008 Santander, Spain; (A.C.); (B.A.-M.); (N.V.-R.); (D.P.-P.); (J.S.-M.); (R.B.)
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, 39011 Santander, Spain
| | - Cristina Almeida
- Division of Rheumatology, Hospital Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (C.A.); (J.C.Q.-A.)
| | - Juan Carlos Quevedo-Abeledo
- Division of Rheumatology, Hospital Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (C.A.); (J.C.Q.-A.)
| | - Ricardo Blanco
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39008 Santander, Spain; (A.C.); (B.A.-M.); (N.V.-R.); (D.P.-P.); (J.S.-M.); (R.B.)
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, 39011 Santander, Spain
| | - Miguel Á. González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39008 Santander, Spain; (A.C.); (B.A.-M.); (N.V.-R.); (D.P.-P.); (J.S.-M.); (R.B.)
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, 39011 Santander, Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- Correspondence: (I.F.-A.); (M.Á.G.-G.)
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Martín-González C, Ferrer-Moure C, Quevedo-Abeledo JC, González-Gay MÁ, Ferraz-Amaro I. Apolipoprotein C3 and beta-cell dysfunction are linked in patients with systemic lupus erythematosus. Clin Exp Rheumatol 2021; 40:2032-2037. [DOI: 10.55563/clinexprheumatol/cezjnr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Candelaria Martín-González
- Division of Internal Medicine, Hospital Universitario de Canarias, Tenerife, and Department of Internal Medicine, University of La Laguna (ULL), Tenerife, Spain
| | - Carmen Ferrer-Moure
- Division of Central Laboratory, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Miguel Ángel González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases; Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain; and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Iván Ferraz-Amaro
- Department of Internal Medicine, University of La Laguna (ULL), Tenerife, and Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain.
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García-Dorta A, Quevedo-Abeledo JC, Rua-Figueroa Í, de Vera-González AM, González-Delgado A, Medina-Vega L, González-Rivero AF, Francisco-Hernández F, González-Gay MA, Ferraz-Amaro I. Beta-cell function is disrupted in patients with systemic lupus erythematosus. Rheumatology (Oxford) 2021; 60:3826-3833. [PMID: 33369681 DOI: 10.1093/rheumatology/keaa874] [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: 10/08/2020] [Revised: 11/16/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To investigate how markers of beta-cell secretion (proinsulin-processing metabolites) are expressed in SLE patients and their potential relation to features associated with the disease such as activity or damage. METHODS One hundred and forty-four SLE patients and 69 nondiabetic sex- and age-matched controls were assessed. Beta-cell secretion molecules, as measured by insulin, split and intact proinsulins, and C-peptide levels were analysed in both groups. Multiple regression analysis was performed to compare proinsulin propeptides between groups and to explore the interrelations with SLE features. Analyses were adjusted for glucocorticoid intake and for insulin resistance classic risk factors. RESULTS Fully multivariable analysis demonstrated that regardless of glucocorticoid use, SLE patients exhibited higher levels of split proinsulin. Likewise, the split proinsulin-to-insulin ratio was upregulated in patients with SLE undergoing glucocorticoid therapy [beta coeficient 0.19 (95% Confidence Interval 0.07, 0.30), P = 0.002] or not [beta coef. 0.09 (95% CI: 0.01, 0.17), P = 0.025]. Similar results were found for the intact proinsulin-to-insulin ratio, although differences were only statistically significant for patients taking glucocorticoids [beta coef. 0.08 (95% CI: 0.03, 0.12), P = 0.001]. SLE damage score was associated with higher serum levels of intact [beta coef. 0.51 (95% CI 0.17, 0.86) pmol/l, P = 0.004] and split proinsulins [beta coef. 1.65 (95% CI 0.24, 3.06) pmol/l, P = 0.022] after multivariable analysis, including disease duration and prednisone use. CONCLUSION Among patients with SLE, proinsulin-processing metabolites, a marker of beta-cell disruption, are upregulated compared with matched controls. This disproportionate hyperproinsulinemia can be explained by the damage produced by the disease and occurs independently of prednisone use.
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Affiliation(s)
- Alicia García-Dorta
- Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Íñigo Rua-Figueroa
- Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | - Lilian Medina-Vega
- Division of Central Laboratory, Hospital Universitario de Canarias, Tenerife, Spain
| | | | | | - Miguel A González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.,Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.,Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain
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Ferraz-Amaro I, Rueda-Gotor J, Genre F, Corrales A, Blanco R, Portilla V, González Mazón I, Llorca J, Expósito R, Vicente EF, Quevedo-Abeledo JC, Rodríguez-Lozano C, Ortega-Castro R, Ladehesa-Pineda ML, Fernández-Carballido C, Martínez-Vidal MP, Castro-Corredor D, Anino-Fernández J, García Vivar ML, Galíndez-Agirregoikoa E, Peiteado D, Plasencia-Rodríguez C, Montes Perez E, Fernández Díaz C, Castañeda S, González-Gay MÁ. Potential relation of cardiovascular risk factors to disease activity in patients with axial spondyloarthritis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211033755. [PMID: 34377161 PMCID: PMC8323406 DOI: 10.1177/1759720x211033755] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/18/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Axial spondyloarthritis (axSpA) patients are known to have a higher
prevalence of several comorbidities, including, among others, an increased
risk of atherosclerosis, hypertension, dyslipidemia, and diabetes. The
purpose of the present study was to determine whether the sum of traditional
cardiovascular (CV) risk factors is related to disease characteristics, such
as disease activity, in patients with axSpA. Methods: A cross-sectional study that encompassed 804 patients with axSpA was
conducted. Patients were assessed for the presence of five traditional CV
risk factors (diabetes mellitus, dyslipidemia, hypertension, obesity, and
smoking status), and disease activity measurements. A multivariable
regression analysis was performed to evaluate whether the number of classic
CV risk factors was independently associated with specific features of the
disease, to include disease activity. Results: A multivariable analysis showed that Ankylosing Spondylitis Disease Activity
Score–C reactive protein (ASDAS-CRP) activity score was significantly higher
in patients with 1 [beta coefficient 0.3 (95% confidence interval (CI)
0.1–0.5), p = 0.001] and ⩾2 [beta coefficient 0.5 (95% CI
0.3–0.7), p = 0.000] CV risk factors compared with those
without CV risk factors. Similarly, patients with 1 [OR 2.00 (95%CI
0.99–4.02), p = 0.053] and ⩾2 [OR 3.39 (95%CI 1.82–6.31),
p = 0.000] CV risk factors had a higher odds ratio for
the presence of high disease activity compared with the zero CV category.
The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) activity
score was significantly associated with the number of CV risk factors, being
higher in patients with more CV risk factors. These relationships showed a
CV risk factor-dependent effect being beta coefficients and ORs higher for
the effect of ⩾2 over 1 CV risk factor. Conclusion: Among patients with axSpA, as the number of traditional CV risk factors
increased, disease activity similarly increases in an independent
manner.
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Affiliation(s)
| | | | - Fernanda Genre
- Epidemiology, Genetics and Atherosclerosis
Research Group on Systemic Inflammatory Diseases, IDIVAL, Santander,
Spain
| | - Alfonso Corrales
- Rheumatology Division, Hospital Universitario
Marqués de Valdecilla, Santander, Spain
| | - Ricardo Blanco
- Rheumatology Division, Hospital Universitario
Marqués de Valdecilla, Santander, Spain
| | - Virginia Portilla
- Rheumatology Division, Hospital Universitario
Marqués de Valdecilla, Santander, Spain
| | - Iñigo González Mazón
- Rheumatology Division, Hospital Universitario
Marqués de Valdecilla, Santander, Spain
| | - Javier Llorca
- Department of Epidemiology and Computational
Biology, School of Medicine, University of Cantabria, and CIBER
Epidemiología y Salud Pública (CIBERESP), Santander, Spain
| | - Rosa Expósito
- Rheumatology Division, Hospital Comarcal,
Laredo, Cantabria, Spain
| | - Esther F. Vicente
- Rheumatology Division, Hospital Universitario
de La Princesa, IIS-Princesa, Madrid, Spain
| | | | - Carlos Rodríguez-Lozano
- Rheumatology Division, Hospital Universitario
de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | | | - M Paz Martínez-Vidal
- Rheumatology Division, Hospital General
Universitario de Alicante, Alicante, Spain
| | - David Castro-Corredor
- Rheumatology Division, Hospital General
Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | | | | | | | | | - Santos Castañeda
- Rheumatology Division, Hospital Universitario
de La Princesa, IIS-Princesa, Madrid, Spain
| | - Miguel Ángel González-Gay
- Rheumatology Division and Epidemiology,
Genetics and Atherosclerosis Research Group on Systemic Inflammatory
Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander,
Spain
- School of Medicine, University of Cantabria,
Santander, Spain
- University of the Witwatersrand,
Cardiovascular Pathophysiology and Genomics Research Unit, School of
Physiology, Faculty of Health Sciences, South Africa
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Quevedo-Abeledo JC, Caceres L, Palazuelos C, Llorca J, González-Gay MÁ, Ferraz-Amaro I. QRISK3 Relation to Carotid Plaque is Higher than that of SCORE In Patients with Systemic Lupus Erythematosus. Rheumatology (Oxford) 2021; 61:1408-1416. [PMID: 34240117 DOI: 10.1093/rheumatology/keab531] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/01/2021] [Accepted: 04/19/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) has been described as an independent risk factor for the development of cardiovascular (CV) disease. Recently, the QRESEARCH risk estimator version 3 (QRISK3) calculator has been launched for CV risk assessment in the general population. QRISK3 now includes the presence of SLE as one of its variables for calculating CV risk. Our objective was to compare the predictive capacity between QRISK3 and the Systematic Coronary Risk Assessment (SCORE) for the presence of subclinical carotid atherosclerosis in patients with SLE. METHODS 296 patients with SLE were recruited. The presence of subclinical atherosclerosis was evaluated by carotid ultrasound to identify carotid plaque and the thickness of the carotid intima media (cIMT). QRISK3 and SCORE were calculated. The relationship of QRISK3 and SCORE with each other and with the presence of subclinical carotid atherosclerosis (both carotid plaque and cIMT) was studied. RESULTS There was no correlation between SCORE and QRISK3 in patients with SLE (Rho Spearman r= -0.008, p= 0.90). Although QRISK3 showed a statistically significant correlation with cIMT (Rho Spearman r = 0.420, p= 0.000), this relationship was not found between SCORE and cIMT (Rho Spearman r= -0.005, p= 0.93). The discrimination capacity of QRISK3 for the presence of carotid plaque was statistically significant and superior to that of SCORE (AUC 0.765 [95% CI 0.711-0.820] vs 0.561 [95% CI 0.494-0.629], p= 0.000). CONCLUSION QRISK3 discrimination for subclinical atherosclerosis is higher than that of SCORE. QRISK3, and not SCORE, should be used for the calculation of CV risk in patients with SLE.
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Affiliation(s)
| | - Laura Caceres
- Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Javier Llorca
- University of Cantabria, Santander, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain
| | - Miguel Á González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.,Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.,Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain
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Quevedo-Abeledo JC, Hernández-Díaz M, Sánchez-Pérez H, Medina-Vega L, González-Rivero AF, Almeida-Santiago C, de Armas-Rillo L, González-Gay MÁ, Ferraz-Amaro I. Amylin serum levels are upregulated in patients with systemic lupus erythematosus. Clin Exp Rheumatol 2021; 40:1378-1384. [DOI: 10.55563/clinexprheumatol/h5cidq] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | - Lilian Medina-Vega
- Division of Central Laboratory, Hospital Universitario de Canarias, Tenerife, Spain
| | | | | | | | - Miguel Ángel González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain; and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain.
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Ferraz-Amaro I, Corrales A, Quevedo-Abeledo JC, Vegas-Revenga N, Blanco R, Portilla V, Atienza-Mateo B, González-Gay MÁ. Disease activity influences the reclassification of rheumatoid arthritis into very high cardiovascular risk. Arthritis Res Ther 2021; 23:162. [PMID: 34088356 PMCID: PMC8176689 DOI: 10.1186/s13075-021-02542-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/21/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Previous studies have shown that risk chart algorithms, such as the Systematic Coronary Risk Assessment (SCORE), often underestimate the actual cardiovascular (CV) risk of patients with rheumatoid arthritis (RA). In contrast, carotid ultrasound was found to be useful to identify RA patients at high CV. In the present study, we aimed to determine if specific disease features influence the CV risk reclassification of RA patients assessed by SCORE risk charts and carotid ultrasound. METHODS 1279 RA patients without previous CV events, diabetes, or chronic kidney disease were studied. Disease characteristics including disease activity scores, CV comorbidity, SCORE calculation, and the presence of carotid plaque by carotid ultrasound were assessed. A multivariable regression analysis was performed to evaluate if the reclassification into very high CV risk category was independently associated with specific features of the disease including disease activity. Additionally, a prediction model for reclassification was constructed in RA patients. RESULTS After carotid ultrasound assessments, 54% of the patients had carotid plaque and consequently fulfilled definition for very high CV risk. Disease activity was statistically significantly associated with reclassification after fully multivariable analysis. A predictive model containing the presence of dyslipidemia and hypertension, an age exceeding 54 years, and a DAS28-ESR score equal or higher than 2.6 yielded the highest discrimination for reclassification. CONCLUSION Reclassification into very high CV risk after carotid ultrasound assessment occurs in more than the half of patients with RA. This reclassification can be independently explained by the activity of the disease.
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Affiliation(s)
- Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Alfonso Corrales
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | | | - Nuria Vegas-Revenga
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - Ricardo Blanco
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - Virginia Portilla
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - Belén Atienza-Mateo
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - Miguel Á. González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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30
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González Mazón I, Rueda-Gotor J, Ferraz-Amaro I, Genre F, Corrales A, Calvo Rio V, Palmou Fontana N, Portilla V, Llorca J, Mata C, Hernández-Hernández V, Quevedo-Abeledo JC, Rodríguez-Lozano C, Lopez Medina C, Ladehesa-Pineda ML, Castañeda S, Vicente EF, Fernández-Carballido C, Martínez-Vidal MP, Castro-Corredor D, Anino-Fernández J, Peiteado D, Plasencia-Rodríguez C, García-Vivar ML, Galíndez-Agirregoikoa E, Montes Perez E, Fernández Díaz C, Blanco R, González-Gay MA. Subclinical atherosclerotic disease in ankylosing spondylitis and non-radiographic axial spondyloarthritis. A multicenter study on 806 patients. Semin Arthritis Rheum 2021; 51:395-403. [PMID: 33607385 DOI: 10.1016/j.semarthrit.2021.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/04/2020] [Revised: 12/31/2020] [Accepted: 02/06/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To compare the atherosclerosis disease burden between ankylosing spondylitis (AS) and non-radiographic (nr) axial spondyloarthritis (axSpA) and establish a model that allows to identify high-cardiovascular (CV) risk in axial spondyloarthritis patients. METHODS Cross-sectional study from the AtheSpAin cohort, a Spanish multicenter cohort aimed to study atherosclerosis in axSpA. Carotid ultrasound (US) was performed to determine the carotid intima-media wall thickness (cIMT) and detect the presence of carotid plaques. The European cardiovascular disease risk assessment model, the Systematic COronary Risk Evaluation (SCORE), was also applied. RESULTS A set of 639 patients with AS and 167 patients with nr-axSpA without history of CV events were recruited. AS patients were older showing more CV risk factors and higher values of C reactive protein and erythrocyte sedimentation rate (ESR) than those with nr-axSpA. However, no difference in the prevalence of carotid plaques or in the cIMT was found between both groups in the adjusted analysis. The percentage of patients reclassified from the low and moderate CV risk categories to the very high-risk category due to the presence of carotid plaques was comparable in AS and nr-axSpA (10.7% versus 10.1% and 40.5% versus 45.5%, respectively). A model containing age, BASFI and ESR applied to moderate risk axSpA patients identified 41% of these patients as having very high-risk patients with high specificity (88%). CONCLUSION The atherosclerosis burden is similar in nr-axSpA and AS. As occurred for AS, more than 40% of axSpA patients included in the category of moderate CV risk according to the SCORE are reclassified into very high risk after carotid US, and a clinically relevant proportion of them can be detected by applying a model containing age, BASFI and ESR.
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Affiliation(s)
- Iñigo González Mazón
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Javier Rueda-Gotor
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Av. de Valdecilla, 25, 39008 Santander, Cantabria, Spain.
| | - Iván Ferraz-Amaro
- Rheumatology Division, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Fernanda Genre
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, Santander, Spain
| | - Alfonso Corrales
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Av. de Valdecilla, 25, 39008 Santander, Cantabria, Spain
| | - Vanesa Calvo Rio
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Natalia Palmou Fontana
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Virginia Portilla
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Javier Llorca
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, Santander, Spain.
| | - Cristina Mata
- Rheumatology Division, Hospital Comarcal, Laredo, Cantabria, Spain
| | | | - Juan Carlos Quevedo-Abeledo
- Rheumatology Division, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain.
| | - Carlos Rodríguez-Lozano
- Rheumatology Division, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain.
| | | | | | - Santos Castañeda
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain.
| | - Esther F Vicente
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain.
| | | | | | - David Castro-Corredor
- Rheumatology Division, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
| | | | | | | | | | | | | | | | - Ricardo Blanco
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Av. de Valdecilla, 25, 39008 Santander, Cantabria, Spain.
| | - Miguel Angel González-Gay
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Av. de Valdecilla, 25, 39008 Santander, Cantabria, Spain; School of Medicine, University of Cantabria, Santander, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
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Sánchez-Pérez H, Quevedo-Abeledo JC, de Armas-Rillo L, Rua-Figueroa Í, Tejera-Segura B, Armas-González E, Machado JD, García-Dopico JA, Jimenez-Sosa A, Rodríguez-Lozano C, Díaz-González F, González-Gay MA, Ferraz-Amaro I. Impaired HDL cholesterol efflux capacity in systemic lupus erythematosus patients is related to subclinical carotid atherosclerosis. Rheumatology (Oxford) 2021; 59:2847-2856. [PMID: 32065639 DOI: 10.1093/rheumatology/keaa038] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 07/19/2019] [Revised: 01/11/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Lipid profiles appear to be altered in SLE patients due to disease activity and inflammation. Cholesterol efflux capacity (CEC) is the ability of high-density lipoprotein cholesterol to accept cholesterol from macrophages. CEC has been linked to cardiovascular events in the general population and is impaired in SLE patients. The aim of this study was to establish whether CEC is related to subclinical carotid atherosclerosis in SLE patients. METHODS The present report is of a cross-sectional study that encompassed 418 individuals: 195 SLE patients and 223 controls. CEC, using an in vitro assay, and lipoprotein serum concentrations were assessed in patients and controls. Carotid intima-media thickness and carotid plaques were evaluated in SLE patients. A multivariable analysis was performed to study the relationship of CEC to SLE-related data, lipid profile and subclinical carotid atherosclerosis. RESULTS CEC was downregulated in SLE patients [8.1 (4.2) % vs 16.9 (10.4) %, P = 0.004). This occurred independently of traditional cardiovascular risk factors, statin use or other variations in the lipid profile related to the disease. Traditional cardiovascular risk factors, both in patients and controls, and SLE-related data such as activity, severity or damage were not associated with CEC. After multivariable regression analysis including lipid profile-related molecules, CEC was inversely and independently associated with the presence of carotid plaques in SLE patients [odds ratio 0.87 (95% CI: 0.78, 0.97), P = 0.014]. CONCLUSION CEC is impaired in SLE patients independently of other inflammation-related lipid profile modifications that occur during the disease. CEC is associated with carotid plaques in SLE patients.
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Affiliation(s)
| | | | | | - Íñigo Rua-Figueroa
- Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria
| | - Beatriz Tejera-Segura
- Division of Rheumatology, Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria
| | | | - José David Machado
- Department of Pharmacology, Faculty of Medicine, Universidad de La Laguna
| | | | | | | | - Federico Díaz-González
- Division of Rheumatology, Hospital Universitario de Canarias, Tenerife.,Department of Internal Medicine, Faculty of Medicine, Universidad de La Laguna, La Laguna
| | - Miguel A González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria.,Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.,Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, Tenerife
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Ferraz-Amaro I, Corrales A, Quevedo-Abeledo JC, Atienza-Mateo B, Prieto-Peña D, Blanco R, Llorca J, González-Gay MÁ. The Performance of Vascular Age in the Assessment of Cardiovascular Risk of Patients with Rheumatoid Arthritis. J Clin Med 2020; 9:jcm9124065. [PMID: 33339369 PMCID: PMC7766012 DOI: 10.3390/jcm9124065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 10/25/2020] [Revised: 12/02/2020] [Accepted: 12/15/2020] [Indexed: 01/30/2023] Open
Abstract
Background. Cardiovascular (CV) disease risk prediction models developed for use in the general population have suboptimal performance in patients with rheumatoid arthritis (RA). Vascular age (VA) is a new concept that has been proposed as a measure of CV 'relative' risk instead of the 'absolute' risk that current prediction models provide. In the present study we aim to study the performance of vascular age (VA) in the assessment of CV risk in patients with RA. We additionally aimed to analyze its relation with subclinical atherosclerosis as measured through carotid plaque ultrasound. Methods. A total of 1173 non-diabetic RA patients without previous CV events were included. Disease characteristics, SCORE, VA determined on SCORE and on carotid intima media thickness (cIMT), and the presence of plaque through carotid ultrasound were assessed. The interrelations of VA with SCORE, and its associations with subclinical carotid atherosclerosis were studied. Results. On average, RA patients had both a SCORE determined VA (4.7 years) and a cIMT-based VA (2.4 years) significantly higher than the chronological age. When these differences were analyzed in different age intervals, while VA based on SCORE was significantly higher compared to chronological age in all age ranges, VA determined on cIMT was significantly elevated only in RA patients younger than 60 years. The area under the curve analysis for the association of SCORE and VA with the presence of carotid plaque disclosed no differences between both parameters. VA was associated with the presence of carotid plaque after multivariable regression analysis in patients younger than 60 years old. Conclusion. VA is significantly higher than chronological age in patients with RA. The performance of VA in its relation to carotid plaque is similar to that of the SCORE.
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Affiliation(s)
- Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, 38320 Tenerife, Spain
- Correspondence:
| | - Alfonso Corrales
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39008 Santander, Spain; (A.C.); (B.A.-M.); (D.P.-P.); (R.B.); (M.Á.G.-G.)
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, 39011 Santander, Spain
| | | | - Belén Atienza-Mateo
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39008 Santander, Spain; (A.C.); (B.A.-M.); (D.P.-P.); (R.B.); (M.Á.G.-G.)
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, 39011 Santander, Spain
| | - Diana Prieto-Peña
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39008 Santander, Spain; (A.C.); (B.A.-M.); (D.P.-P.); (R.B.); (M.Á.G.-G.)
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, 39011 Santander, Spain
| | - Ricardo Blanco
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39008 Santander, Spain; (A.C.); (B.A.-M.); (D.P.-P.); (R.B.); (M.Á.G.-G.)
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, 39011 Santander, Spain
| | - Javier Llorca
- University of Cantabria, 39011 Santander, Spain;
- CIBER Epidemiología y Salud Pública (CIBERESP), 39011 Santander, Spain
| | - Miguel Á. González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39008 Santander, Spain; (A.C.); (B.A.-M.); (D.P.-P.); (R.B.); (M.Á.G.-G.)
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, 39011 Santander, Spain
- University of Cantabria, 39011 Santander, Spain;
- Cardiovascular Pathophysiology and Genomics Research Unit, Faculty of Health Sciences, School of Physiology, University of the Witwatersrand, Johannesburg 2193, South Africa
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Quevedo-Abeledo JC, Rúa-Figueroa Í, Sánchez-Pérez H, Naranjo A, de Armas-Rillo L, Tejera-Segura B, Lopez-Mejías R, González-Gay MÁ, Ferraz-Amaro I. Comparable effects of traditional cardiovascular risk factors on subclinical atherosclerosis in systemic lupus erythematosus and rheumatoid arthritis. Clin Exp Rheumatol 2020; 38:917-924. [PMID: 31969232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) have an increased premature prevalence of atherosclerosis. We aimed to determine whether there are differences in the prevalence of classic cardiovascular risk factors between SLE and RA. We also analysed the effect of traditional cardiovascular risk factors on the development of subclinical atherosclerosis in both conditions and if some disease-characteristic features are associated with these traditional cardiovascular risk factors. METHODS This was a cross-sectional study encompassing 602 individuals, 276 SLE and 326 RA patients. Subclinical atherosclerosis (presence of carotid plaques and carotid intima-media thickness [cIMT]) was determined by carotid ultrasonography. A multivariable regression analysis was performed to evaluate whether classic cardiovascular-related risk factors differentially influence subclinical carotid atherosclerosis in SLE compared to RA patients. RESULTS Age (interaction factor [if] p=0.000), hypertension (if p=0.034), and diabetes (if p=0.037) had a higher effect on cIMT in RA than in SLE subjects. However, these traditional cardiovascular factors did not yield different effects on the presence of carotid plaques in RA and SLE when the univariate interaction was analysed. In addition, no differences were found in the influence of hypertension, diabetes, dyslipidaemia or current smoking on cIMT or carotid plaque after adjusting for demographics, the presence of other traditional cardiovascular factors, and disease-related data. Moreover, the additive effect of several cardiovascular risk factors on the subclinical carotid atherosclerosis did not differ between the two diseases. CONCLUSIONS The influence of traditional cardiovascular risk factors on cIMT and carotid plaque is similar in RA and SLE.
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Affiliation(s)
| | - Íñigo Rúa-Figueroa
- Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Antonio Naranjo
- Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | - Raquel Lopez-Mejías
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Miguel Á González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; School of Medicine, University of Cantabria, Santander, Spain; and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Ivan Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain.
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Genre F, Rueda-Gotor J, Quevedo-Abeledo JC, Corrales A, Hernández-Hernández V, Fañanas-Rodríguez N, Lavín-Gómez B, Delgado-Frías E, de Vera-González A, González-Delgado A, de Armas-Rillo L, García-Unzueta MT, González-Gay MÁ, Ferraz-Amaro I. Insulin resistance in non-diabetes patients with spondyloarthritis. Scand J Rheumatol 2020; 49:476-483. [PMID: 32648492 DOI: 10.1080/03009742.2020.1751272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: Insulin resistance (IR) constitutes a major underlying abnormality driving cardiovascular disease in the general population and has been linked to inflammatory diseases. In this study, we aimed to determine the prevalence of IR in patients with spondyloarthritis (SpA) and whether IR can be explained by disease-related features in such cases. Method: The study included 577 subjects: 306 patients diagnosed with SpA according to Assessment of SpondyloArthritis international Society criteria and 271 controls. Insulin and C-peptide serum levels, IR and β-cell function (%B) indices by homoeostatic model assessment (HOMA2), and lipid profiles were assessed in patients and controls. A multivariable regression analysis was performed to evaluate the differences in IR indices between patients and controls and to determine how IR is associated with disease-related characteristics in SpA patients. Results: HOMA2-%B and HOMA2-IR scores, both calculated with insulin or C-peptide, had significantly higher values in SpA patients compared to controls in multivariable analysis adjusted for age, gender, traditional IR-related factors, and glucocorticoid intake. Disease activity, functional status, and metrological SpA indices were positively related to IR, but only in univariable analysis. Disease duration and positivity for human leucocyte antigen-B27 were independently associated with a higher HOMA2-%B after multivariable analysis. Conclusion: Patients with SpA have an increased IR compared to controls. SpA disease-related data are independently associated with β-cell dysfunction.
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Affiliation(s)
- F Genre
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Marqués de Valdecilla University Hospital, IDIVAL , Santander, Spain
| | - J Rueda-Gotor
- Division of Rheumatology, Marqués de Valdecilla University Hospital , Santander, Spain
| | - J C Quevedo-Abeledo
- Division of Rheumatology, University Hospital of Gran Canaria Dr Negrin , Las Palmas, Gran Canaria, Spain
| | - A Corrales
- Division of Rheumatology, Marqués de Valdecilla University Hospital , Santander, Spain
| | - V Hernández-Hernández
- Division of Rheumatology, University Hospital of the Canary Islands , Tenerife, Spain
| | - N Fañanas-Rodríguez
- Division of Endocrinology, Marqués de Valdecilla University Hospital , Santander, Spain
| | - B Lavín-Gómez
- Division of Endocrinology, Marqués de Valdecilla University Hospital , Santander, Spain
| | - E Delgado-Frías
- Division of Rheumatology, University Hospital of the Canary Islands , Tenerife, Spain
| | - A de Vera-González
- Central Laboratory Division, University Hospital of the Canary Islands , Tenerife, Spain
| | - A González-Delgado
- Central Laboratory Division, University Hospital of the Canary Islands , Tenerife, Spain
| | - L de Armas-Rillo
- Department of Health Sciences, European University of the Canary Islands , Tenerife, Spain
| | - M T García-Unzueta
- Division of Endocrinology, Marqués de Valdecilla University Hospital , Santander, Spain
| | - M Á González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Marqués de Valdecilla University Hospital, IDIVAL , Santander, Spain.,Division of Rheumatology, Marqués de Valdecilla University Hospital , Santander, Spain.,School of Medicine, University of Cantabria , Santander, Spain.,Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, South Africa
| | - I Ferraz-Amaro
- Division of Rheumatology, University Hospital of the Canary Islands , Tenerife, Spain
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Rueda-Gotor J, Quevedo-Abeledo JC, Corrales A, Genre F, Hernández-Hernández V, Delgado-Frías E, González-Gay MÁ, Ferraz-Amaro I. Reclassification into very-high cardiovascular risk after carotid ultrasound in patients with axial spondyloarthritis. Clin Exp Rheumatol 2020; 38:724-731. [PMID: 32083538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Subclinical atherosclerosis, defined as the presence of carotid plaques, is more frequently found in patients with axial spondyloarthritis (axSpA) than in healthy individuals. We sought to determine whether axSpA patients are more commonly reclassified into the very high cardiovascular risk category than controls after performing carotid ultrasound and if this can be linked to disease characteristics. METHODS 343 patients diagnosed with axSpA according to ASAS criteria and 177 controls were studied. Disease characteristics and Systematic Coronary Risk Evaluation (SCORE) were assessed in patients and controls. Presence of plaques and intima-media thickness (cIMT) was determined by carotid ultrasound. Multivariable regression analysis was performed to identify differences in the frequency of reclassification between patients and controls, as well as factors associated with reclassification in axSpA. RESULTS Carotid plaques (36% vs.25%, p=0.010) and higher cIMT (0.641± 0.121 vs. 0.602± 0.115 mm, p=0.001) were more common in patients than controls. Reclassification into the high-risk category was greater in patients (34% vs. 25%, p=0.037). Age (beta coefficient 2.74 [95%CI 1.34-5.62] vs. beta coef. 0.63 (95%CI 0.40-0.99) in patients, interaction p=0.001) and serum LDL-cholesterol (beta coef. 1.03 [95%CI 1.02-1.04] vs. beta coef. 1.00 [0.99-1.01], interaction p=0.029) showed a higher effect on reclassification in controls after multivariable analysis. Although reclassification in axSpA was associated with higher ASDAS-CRP, BASFI and BASMI scores, these associations were lost after adjusting for cardiovascular risk factors. CONCLUSIONS Patients with axSpA are more likely to be reclassified into the very-high risk category after carotid ultrasound than controls. The influence of traditional cardiovascular risk factors on this reclassification differs between patients and controls.
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Affiliation(s)
- Javier Rueda-Gotor
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Alfonso Corrales
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Fernanda Genre
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | | | - Miguel Ángel González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; School of Medicine, University of Cantabria, Santander, Spain; and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Ivan Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain
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Naranjo A, Ojeda-Bruno S, Bilbao-Cantarero A, Quevedo-Abeledo JC, Diaz-González BV, Rodríguez-Lozano C. Two-year adherence to treatment and associated factors in a fracture liaison service in Spain. Osteoporos Int 2015; 26:2579-85. [PMID: 26048675 DOI: 10.1007/s00198-015-3185-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 05/20/2015] [Indexed: 12/22/2022]
Abstract
UNLABELLED A fracture liaison service in Spain is able to maintain 73 % of the patients on antiresorptive 2 years after the fracture. INTRODUCTION The purpose of this study was to evaluate the 2-year effectiveness of a program for the secondary prevention of fractures. METHODS Fragility fractures in patients over 50 attending the emergency room in our centre are captured by the recruitment system of a secondary prevention program. The unit is attended by a nurse, coordinated by two rheumatologists and with the collaboration of primary care consisted of a training program and annual meetings. The outcome of the program was analysed 2 years after implementation, including: (1) percentage of attendees/eligible; (2) percentage of attendees who start treatment with antiresorptive; (3) percentage of patients who retain treatment after 6, 12, 18 and 24 months; and (4) factors associated to adherence. RESULTS After 2 years of implementation, the program detected 1674 patients with fracture, of whom 759 finally entered the program (57 % of eligible). After 3 months, 82 % of patients prescribed an antiresorptive started treatment. After a year, 52 % of the patients in the program, 72 % of those of a prescribed treatment, were taking antiresorptives. Adherence at 24 months among those who had prescribed anti-fracture drugs was 73 %. Factors associated with adherence at 12 months were female sex (76 vs 45 %; p = 0.01) and previous treatment with antiresorptive (86 vs 68 %; p = 0.02). CONCLUSIONS In Spain, a program designed to prevent secondary fragility fractures based on the collaboration between primary care and rheumatology seems effective in terms of recruitment of patients and adherence to treatment in the mid/long-term.
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Affiliation(s)
- A Naranjo
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de La Ballena s/n, 35011, Las Palmas de Gran Canaria, Spain.
- Medical and Surgical Sciences Department, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - S Ojeda-Bruno
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de La Ballena s/n, 35011, Las Palmas de Gran Canaria, Spain
| | - A Bilbao-Cantarero
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de La Ballena s/n, 35011, Las Palmas de Gran Canaria, Spain
| | - J C Quevedo-Abeledo
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de La Ballena s/n, 35011, Las Palmas de Gran Canaria, Spain
| | - B V Diaz-González
- Primary Care Service, Gerencia de Atención Primaria de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - C Rodríguez-Lozano
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de La Ballena s/n, 35011, Las Palmas de Gran Canaria, Spain
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