Treat to target and prevention of subclinical atherosclerosis in psoriatic arthritis—which target should we choose?

Rheumatology ◽  
2020 ◽  
Vol 59 (10) ◽  
pp. 2881-2892
Author(s):  
Isaac T Cheng ◽  
Edmund K Li ◽  
Priscilla C Wong ◽  
Mei Yan Law ◽  
Isaac C Yim ◽  
...  

Abstract Objective PsA patients who achieved sustained minimal disease activity (sMDA) had less subclinical atherosclerosis progression. The vascular effects of achieving other potential treatment targets, including the PsA Disease Activity Score (PASDAS) and the Disease Activity in PsA (DAPSA) score, remained uncertain. This study aimed to compare the vascular effects of achieving different treatment targets in PsA patients. Method This is a post hoc analysis of a 2 year treat-to-target study aimed at MDA. A total of 101 consecutive PsA patients without overt cardiovascular disease were recruited. High-resolution carotid ultrasound and arterial stiffness markers were assessed annually. Low disease activity (LDA) was defined as MDA, DAPSA ≤14 or PASDAS ≤3.2. Sustained disease control was defined as achieving these targets at each visit from month 12 until month 24. Results Ninety patients [52 male (57.8%), age 50 years (s.d. 11)] who completed 24 months of follow-up were included in this analysis. A total of 44%, 48% and 45% of patients achieved sustained DAPSA LDA (sDAPDA-LDA), sustained PASDAS LDA (sPASDAS-LDA) and sMDA, respectively. Patients who achieved sMDA had significantly less progression of carotid intima-media thickness than those who did not (P = 0.031). Using multivariate analysis, achieving sMDA and sPASDAS-LDA had a protective effect on plaque progression, less increase in total plaque area, reduced mean intima-media thickness and reduced augmentation index after adjusting for covariates. In contrast, no significant differences in the progression of vascular parameters were demonstrated between patients who did or did not achieve sDAPSA-LDA. Conclusion Achieving sMDA/sDASPAS-LDA, but not sDAPSA-LDA, was associated with a protective effect in subclinical atherosclerosis and arterial stiffness progression. A multidimensional domain of disease control might be better in minimizing cardiovascular risk in PsA.

2021 ◽  
pp. 95-95
Author(s):  
Gonca Sağlam ◽  
Mehmet Turgut ◽  
Oktay Gülcü

Objective: Epidemiological studies indicate that cardiovascular disease is common in almost all patients diagnosed with autoimmune disease. This study aimed to examine whether Epicardial adipose tissue (EAT) and carotid intima media thickness (CIMT) differ among patients with Beh?et?s Disease (BD) and healthy individuals. Methods: A total of 40 healthy subjects as controls and 40 BD patients with musculoskeletal complaints were enrolled in this cross-sectional prospective study. Socio-demographic, clinical and laboratory data were obtained and compared between groups. Beh?et?s Disease Current Activity Form was used to assess disease activity. Both groups underwent echocardiography to measure EAT and CIMT. Results: The mean thickness of EAT (5.70?1.05; 2.50?0.61, respectively, p<0.001) and CIMT (0.68?0.05; 0.63?0.06, respectively, p: 0.002) were significantly increased in BD patients compared to the control group. A positive correlation was observed between EAT thickness and age (r:0.500, p:0.001), the duration of the disease (r:0.330, p<0.001), waist circumference (r:0.316, p: 0.013), and disease activity (r: 0.31, p<0.001) in the patient group. The CIMT was positively correlated with age (r: 0.594, p: 0.001) and the duration of the disease (r: 0.585, p: 0.001). Use of glucocorticoids or clinical manifestations (joint involvements, genital ulcer, skin lesions, inflammatory back pain and major organ involvement) of the patients were not found to be associated with EAT or CIMT. Conclusion: The thickness of EAT and CIMT are increased in patients with BD that are associated with disease activity. Echocardiographic measurement of EAT and CIMT is an objective, noninvasive and available method that can evaluate the risk of subclinical atherosclerosis in patients with BD.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 526.2-526
Author(s):  
L. Nacef ◽  
H. Ferjani ◽  
K. Maatallah ◽  
Y. Mabrouk ◽  
H. Riahi ◽  
...  

Background:Patients with rheumatoid arthritis (RA) are exposed to a multifactorial cardiovascular risk: chronic inflammation, endogenous and exogenous factors, and treatment.Objectives:The aim of this study was to investigate the impact of RA treatments on cardiovascular risk and the influence of supra aortic trunks.Methods:This is a prospective study conducted on RA patients followed-up between March and December 2020 at the rheumatology department of the Mohamed Kassab Institute of Orthopedics and Traumatology. Socio-demographic data of patients and characteristics of the disease were collected. The disease activity was evaluated by the Disease Activity Score 28. Prescribed treatments were specified. Ultrasonography of the supra aortic trunks was performed by measuring, in centimeters, the Intima-media Thickness (IMT) at the level of the left (LCC) and right (RCC) common carotid arteries, the left (LIC) and right (RIC) internal carotid arteries and the left (LEC) and right (REC) internal carotid arteries.Results:Of the 47 patients surveyed, 78.7% were female. The mean age was 52.5 ±11.06 [32-76]. The average RA progressed from 86.25 ±63 [5-288] and was erosive in 81.6% of cases. The rheumatoid factor (RF) was positive in 57.8% of patients, and citrullinated antipeptide antibodies (ACPA) were present in 62.2%. The treatments taken were: Methotrexate (MTX) (54.5%), Sulfasalazine (SLZ) (1.8%), Leflunomide (LFN) (3.6%), a combination of cs-DMARDs (5.5%), and biotherapy (10.9%). The prescribed biotherapies were: Etanercept (3.6%), Adalimumab (1.8%), Certolizumab (1.8%), Infliximab (3.6%). Corticosteroids (CT) were prescribed in 38.2% of patients, non-steroidal anti-inflammatory drugs (NSAIDs) (3.6%), and analgesics (41.8%).CT had a protective effect on IMT in LIC (p=0.031) and RIC (p=0.016). MTX had a significant protective effect on IMT in RIC (p=0.002) and LEC (p=0.033).SLZ was associated with an increase in IMT at the RIC level (p=0.05). There was no association between NSAID use and IMT. MTX and CT were significantly associated with a decrease in SCORE (p=0.02; p=0.05, respectively). There was a non-significant association between SLZ or LFN and decreased SCORE (p=0.140, p=0,970).Conclusion:In our series, patients taking MTX and CT had a lower IMT than those not taking these drugs. SLZ was associated with an increase in IMT. NSAIDs did not affect IMT in our study.References:[1]Pasquale Ambrosino and al, Subclinical atherosclerosis in patients with rheumatoid arthritis A meta-analysis of literature studies. Thrombosis and Haemostasis 113.5/2015[2]Hyun-Je Kim and al, Effects of Methotrexate on Carotid Intima-media Thickness in Patients with Rheumatoid Arthritis. The Korean Academy of Medical Sciences 2015.Disclosure of Interests:None declared


2009 ◽  
Vol 52 (3) ◽  
pp. 107-116 ◽  
Author(s):  
Sadhanah Aqashiah Mazlan ◽  
Mohd Shahrir bin Mohamed Said ◽  
Heselynn Hussein ◽  
Khadijah binti Shamsuddin ◽  
Shamsul Azhar Shah ◽  
...  

Introduction: Psoriatic Arthritis (PsA) is an inflammatory arthritis associated with Psoriasis. Its recognition as an inflammatory disease distinct from Rheumatoid Arthritis has put forward for consideration several questions regarding its specific CVS mortality and morbidity (9, 11, 16, 26). Carotid intima media thickness is a useful surrogate and sensitive marker to determine atherosclerosis even in its subclinical stages (6, 14, 22, 27, 32). Objective: Prevalence of carotid intima media thickness in patients with Psoriatic arthritis is unknown in Asian population. We aim to identify the presence of subclinical atherosclerosis in patients with psoriatic arthritis and disease activity association and its predictors in a series of patients with PsA attended to the rheumatology clinic, tertiary hospitals. Methods: A total of 63 patients with PsA who fulfilled the CASPAR criteria were recruited from UKM Medical Centre and Hospital Putrajaya. Common carotid intima media thickness (IMT) was measured in both right and left carotid artery by using high resolution B-mode ultrasound. This was a cross sectional study first done in Malaysia for PsA patients. Results: The positive IMT (IMT >1.00 mm) among PsA was observed in 10 out of 63 patients (15.9 %) regardless of background cardiovascular risk. The mean±SD of IMT was 0.725 ±0.260 mm for this study. Variables significantly associated with positive IMT (p<0.05) included age at the time of study (p=0.005), waist circumference (p=0.001), Hypertension (p=0.007), Diabetes (p=0.002) and Metabolic syndrome (p=0.001) and not associated with gender, ethnicity, duration of PsA disease, pattern of PsA, disease activity and severity. Above all, only age had positive IMT independent predictor (p=0.032), with OR 1.116; 95 % CI (1.010–1.234). Conclusions: There was a significant association between CVS risk and positive Intima Media Thickness in Psoriatic Arthritis patients. Otherwise, there was no association in disease activity, disease severity and DMARDS therapy with positive Intima Media Thickness in Psoriatic Arthritis patients. The study was approved by Research and Ethics Committee of the faculty of medicine, Universiti Kebangsaan Malaysia with project code FF-114-2008 and by Community Research Center (CRC) of National Institutes of Health (NIH) for the case study in Hospital Putrajaya with the project code NMRR-08- 970-2125.


2021 ◽  
Vol 11 (4) ◽  
pp. 284-291
Author(s):  
K. N. Safarova ◽  
V. I. Makhina ◽  
K. D. Dorogoykina ◽  
A. P. Rebrov

Aim: to study parameters of arterial stiffness and subclinical atherosclerosis in patients with axial spondyloarthritis (axSpA) without clinically manifest cardiovascular pathology depending on the presence of anemia.Material and methods. 102 patients with axSpA (mean age – 37.7±9.8 years, axSpA duration – 13.5±8.7 years, 66 (64.7%) men) were included. The BASDAI index and C-reactive protein (CRP)-based ASDAS score were measured, the hemogram, the erythrocyte sedimentation rate (ESR), and the level of CRP were studied. Parameters of arterial stiffness were studied by oscillography and photoplethysmography, intima-media thickness (IMT) was evaluated by B-mode ultrasound according to standard protocols.Results. During analysis of pulse wave properties, no statistically significant differences in parameters of vascular wall stiffness were found in axSpA patients with and without anemia. Aortic pulse wave velocity (PWVao) in patients with anemia was 7.4±1.5 m/sec, aortic augmentation index (Aix-ao) was 19.1±13.7%, stiffness index (SI) was 8.2±1.7 m/sec; in patients without anemia – 7.4±1.4 m/sec, 17.3±10.6% and 8.8±2.0 m/sec, respectively (p >0.05 for all). IMT in patients with anemia was 0.70±0.13 cm, in patients without anemia – 0.73±0.16 cm (p >0.05). Correlation analysis was performed and significant correlations were noted between Aix-ao, PWVao, SI, IMT and age (r=0.488, r=0.516, r=0.289, r=0.461, respectively, p <0.05); Aix-ao, PWVao and the BASDAI index (r=0.243, r=0.253, respectively, p <0.05). Significant correlations between PWVao and Aix-ao (r=0.442, p <0.001), SI (r=0.273, p=0.011) and IMT (r=0.236, p=0.034) were found.Conclusion. The present study did not confirm the negative effect of anemia on vascular wall stiffness parameters and IMT in patients with axSpA. We consider that potential protective effect of anemia, due to well-known pathophysiological patterns — a decrease in blood viscosity and the induction of nitric oxide synthesis, plays an important role. Further studies are required to assess relationship between hemoglobin levels and markers of endothelial dysfunction in patients with axSpA.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1119.3-1120
Author(s):  
L. Nacef ◽  
H. Ferjani ◽  
H. Riahi ◽  
Y. Mabrouk ◽  
E. Labbene ◽  
...  

Background:Patients with rheumatoid arthritis (RA) are at higher cardiovascular risk (CVR) than the general population due to chronic inflammation. Several factors, both modifiable and non-modifiable, can increase this risk. Intima-media thickness (IMT) was considered as a marker for atherosclerosis.Objectives:This study aimed to identify predictor factors of increasing IMT.Methods:The prospective study was carried out on patients with RA who met the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria. These patients were followed in the rheumatology department of the Kassab Institute. The socio-demographic data, biological and immunological parameters were collected.Framingham’s score quantified the cardiovascular risk at 10-years. Carotid Ultrasonography (US) using a high resolution B mode carotid measured intima-media thickness (IMT) as a subclinical marker of atherosclerosis. Carotid US was performed in the supine position, according to American Society of Echocardiography guidelines. IMT was measured in the left (LCC) and right (RCC) common carotid arteries, the left (LIC) and right (RIC) internal carotid arteries, and the left (LEC) and right (RIC) internal carotid arteries. An increased IMT was defined as ≥0.9 mm.We analyzed data by the SPSS statistical package. A p-value <0.05 was considered significant.Results:Of the 47 patients surveyed, 78.7% were female. The mean age was 52.5 ±11.06 [32-76]. The duration disease was 86.25 ±63 months [5-288] and was erosive in 81.6% of cases. The rheumatoid factor (RF) was positive in 57.8% of patients, and citrullinated antipeptide antibodies (ACPA) were present in 62.2%. Eight patients had a previous CV history (hypertension, diabetes or dyslipidemia) and 16.4% were active smokers. Among women, 43.6% were postmenopausal. ITM was significantly higher in men at LIC (0.037) and LEC (0.025). Older age was associated with increased ITM in LIC (p=0.046; r=0.295), LEC (p=0.05; r=0.412), RCC (p=0.034; r=0.317), and REC (p=0.009; r=0.382). The ITM for LCC, LIC, LEC, RCC, RIC, and REC was higher in postmenopausal women, with no significant difference (p=0.782, p=0.208, p=0.877, r=0.734, p=0.808, p=0.437, respectively).Among the modifiable factors, active smoking was associated with a higher ITM at the REC level (p=0.047). However, weight was not associated with an increased ITM (LCC: p=0.092; LIC: p=0.985; LEC: p=0.952; RCC: p=0.744; RIC: p=0.210; REC: p=0.510). In our study, there was no significant association between DAS28 disease activity or inflammatory marks and ITM (LCC: p=0.784; LIC: p=0.316; LEC: p=0.420; RCC: p=0.784; RIC: p=0.484; REC: p=0.754).Conclusion:In our study, the non-modifiable factors associated with increased ITM were advanced age and male gender. The modifiable factor impacting ITM was primarily active smoking. Surprisingly, disease activity and biological inflammation did not influence ITM.References:[1]S. Gunter and al. Arterial wave reflection and subclinical atherosclerosis in rheumatoid arthritis. Clinical and experimental rheumatology 2018; 36: clinical e.xperimental.[2]Aslan and al. Assessment of local carotid stiffness in seronegative and seropositive rheumatoid Arthritis. Scandinavian cardiovascular journal, 2017.[3]Martin i. Wah-suarez and al, carotid ultrasound findings in rheumatoid arthritis and control subjects: a case-control study. Int j rheum dis. 2018;1–7.Disclosure of Interests:None declared


2020 ◽  
pp. 1-8
Author(s):  
Silvia M. Cardoso ◽  
Michele Honicky ◽  
Yara M. F. Moreno ◽  
Luiz R. A. de Lima ◽  
Matheus A. Pacheco ◽  
...  

Abstract Background: Subclinical atherosclerosis in childhood can be evaluated by carotid intima-media thickness, which is considered a surrogate marker for atherosclerotic disease in adulthood. The aims of this study were to evaluate carotid intima-media thickness and, to investigate associated factors. Methods: Cross-sectional study with children and adolescents with congenital heart disease (CHD). Socio-demographic and clinical characteristics were assessed. Subclinical atherosclerosis was evaluated by carotid intima-media thickness. Cardiovascular risk factors, such as physical activity, screen time, passive smoke, systolic and diastolic blood pressure, waist circumference, dietary intake, lipid parameters, glycaemia, and C-reactive protein, were also assessed. Factors associated with carotid intima-media thickness were analysed using multiple logistic regression. Results: The mean carotid intima-media thickness was 0.518 mm and 46.7% had subclinical atherosclerosis (carotid intima-media thickness ≥ 97th percentile). After adjusting for confounding factors, cyanotic CHD (odds ratio: 0.40; 95% confidence interval: 0.20; 0.78), cardiac surgery (odds ratio: 3.17; 95% confidence interval: 1.35; 7.48), and be hospitalised to treat infections (odds ratio: 1.92; 95% confidence interval: 1.04; 3.54) were associated with subclinical atherosclerosis. Conclusion: Clinical characteristics related to CHD were associated with subclinical atherosclerosis. This finding suggests that the presence of CHD itself is a risk factor for subclinical atherosclerosis. Therefore, the screen and control of modifiable cardiovascular risk factors should be made early and intensively to prevent atherosclerosis.


Author(s):  
Eliana Portilla-Fernández ◽  
Shih-Jen Hwang ◽  
Rory Wilson ◽  
Jane Maddock ◽  
W. David Hill ◽  
...  

AbstractCommon carotid intima-media thickness (cIMT) is an index of subclinical atherosclerosis that is associated with ischemic stroke and coronary artery disease (CAD). We undertook a cross-sectional epigenome-wide association study (EWAS) of measures of cIMT in 6400 individuals. Mendelian randomization analysis was applied to investigate the potential causal role of DNA methylation in the link between atherosclerotic cardiovascular risk factors and cIMT or clinical cardiovascular disease. The CpG site cg05575921 was associated with cIMT (beta = −0.0264, p value = 3.5 × 10–8) in the discovery panel and was replicated in replication panel (beta = −0.07, p value = 0.005). This CpG is located at chr5:81649347 in the intron 3 of the aryl hydrocarbon receptor repressor gene (AHRR). Our results indicate that DNA methylation at cg05575921 might be in the pathway between smoking, cIMT and stroke. Moreover, in a region-based analysis, 34 differentially methylated regions (DMRs) were identified of which a DMR upstream of ALOX12 showed the strongest association with cIMT (p value = 1.4 × 10–13). In conclusion, our study suggests that DNA methylation may play a role in the link between cardiovascular risk factors, cIMT and clinical cardiovascular disease.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1428.2-1428
Author(s):  
V. Valinotti ◽  
A. Paats ◽  
R. Acosta ◽  
L. Roman ◽  
I. Acosta-Colman ◽  
...  

Background:The mechanism of increased cardiovascular risk in RA is not well understood and is independent of traditional CV risk factors. Intima-media thickness of the common carotid wall measured by ultrasonogram is a safe and useful biomarker of early stage atherosclerosis that correlates with coronary involvement; and it correlates with severity and duration of disease. Several studies have shown a relationship between inflammation markers, endothelial dysfunction markers, and carotid involvement. (1)Objectives:To determine the presence of inflammation biomarkers and its relationship with subclinical atherosclerosis measured by carotid ultrasound, and with the clinical characteristics in patients with established Rheumatoid Arthritis (RA)Methods:Descriptive, cross sectional, prospective study, in a Paraguayan cohort of patients with RA meeting ACR/EULAR2010 criteria. This study had two phases: the first one, included a standardized questionnaire according to the variables included in the Cardiovascular Risk project (PINV15-0346), from the National Sciences and Technology Council (CONACYT), and physical examination; the second one included laboratory sample collection performed by a specialized laboratory for serum biomarkers measurement for cardiovascular risk prediction (i.e endothelin, alpha-TNF, E-selectin, homocysteine, apolipoprotein, fibrinogen, and high sensitivity-CRP levels) and carotid ultrasound evaluation by a trained specialist, to evaluate subclinical atherosclerosis. Subclinical atherosclerosis was defined as carotid intima-media thickness (CIMT) >0,9mm and/or presence of carotid plaques. All patients signed informed consent. SPSS 23rd version was used for data analysis. Quantitative variables were presented as means and qualitative as frequencies. Chi square test was performed for comparisons between dichotomous variables and t Student for continuous, and p ≤ 0.05 for statistical significance.Results:100 patients were included, 87% were women, mean disease duration 130.9±102.64 months, 77% were RF positive, and 84.4% were ACPA positive, 43.4% had bone erosions, mean ESR-DAS28 was 3,42±1,1; 30% had remission criteria. 39% had extra-articular manifestations.Elevated serum biomarkers were found: fibrinogen >400 mg/dL 88.2%, high sensitivity-CRP (hs-CRP) >5mg/dL 42.9%, endothelin >2 ng/mL 20%, alpha-TNF >15,6 pg/mL 13.1%, E-selectin >79,2 ng/mL 6%. 25.3% had CIMT >0,9 mm and mean CIMT was 0.68±0.25mm. 27.14% had carotid plaques. Patients with CIMT>1mm had higher frequency of family history of arterial hypertension (p=0.006), greater mean disease duration (p=0.0007), hip circumference (p=0.014), blood pressure (SBP p=0.038, DBP p=0.027), HAQ levels (p=0,019) and hs-CRP levels (p=0.013), also lower mean height (p=0,04); while carotid plaques were related to higher homocysteine (p=0.026) and hs-CRP levels (p=0.024).Conclusion:A considerable percentage of patients had subclinical atherosclerosis. Patients with CIMT>0,9mm had a longer disease duration, higher HAQ levels, hip circumference, as well as higher BP. High levels of hs-CRP were more frequently related to the presence of subclinical atherosclerosisReferences:[1]Aday, A. targeting residual inflammatory risk: a shifting paradigm for atherosclerotic disease. Frontiers in cardiovascular medicine. 2019. 6:16.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6403155/pdf/fcvm-06-00016.pdfDisclosure of Interests:None declared


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