SAT0393 DISCREPANCY IN THE CARDIOVASCULAR RISK SEVERITY CALCULATED USING DIFFERENT RATING SCALES IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS

Background:Cardiovascular risk (CVR) in patients (pts) with axial spondyloarthritis (axSpA) exceed the populational level. However, it remains unclear, which of the cardiovascular risk assessment systems is the most accurate in cases of chronic inflammation..Objectives:of the current study were to assess the CVR in pts with axSpA and to compare different cardiovascular risk scales in these pts.Methods:The study included 118 patients at the age of 25-65 years with diagnosis of axSpA fulfilling ASAS criteria (2009) from St. Petersburg’ axSpA register. Three indices of cardiovascular risk evaluation (Systematic COronary Risk Evaluation (SCORE) with increasing coefficient 1.5 for inflammatory diseases, Reynolds Risk Score (RRS), and the third modification of QRESEARCH Cardiovascular Risk Algorithm (QRISK3) were calculated. For the pts below 40 years old only QRISK3 was calculated.Results:Mean age of the pts was 44.3±11.1 years; 91(77.1%) pts were males, HLA-B27 positive – 83 (70.3%) of the pts; mean disease duration 13.0±8.3 years. Mean value of SCORE was 2.78±1.89%, of RRS – 5.28±3.31%, of QRISK3 – 7.91±3.8% (figure 1). Cronbach’s alpha for the scales was 0.873.Figure 1.Cardiovascular risk evaluation indices in patients with axial spondyloarthritis, n=118 for QRISK3, n=72 for SCORE and RRS.High CVR (≥5 %) was found in 14 (11,7%) of the pts according to the SCORE, in 65 (55,1%) of the pts according to the RRS, and in 81 (69%) of the pts according to the QRISK3. Ranking of CVR severity did not match in SCORE and QRISK3 indices in 83.72% of cases, in SCORE and RRS – in 51.16% of cases, and in QRISK3 and RRS in 8% of cases. The SCORE index showed the lower values of the expected risk as compared to the QRISK3 and RRS (figure1).In axSpA pts at age 25-40 years old (n=46, mean age 32.6±4.0 years, males 36 (78.3%)), mean value of QRISK3 was 1.16±0.99 %; in 14 from 46 (30.4%) of those pts increased CVR was registered (figure 2).Figure 2.QRISK3 index in axSpA patients 25-40 years old, n=46Conclusion:There was a discrepancy in the severity of CVR calculated using different rating scales in axSpA patients. The SCORE index showed lower values of CVR as compared to the QRISK3 and RRS, which hypothetically could be the consequence of CVR underestimation. QRISK3 demonstrated the highest CVR and was the only index useful in pts below 40 years old. To exclude hyper- or underestimation of CVR calculation more data about CVR calculations and frequency of CV events, occurring in axSpA patients are needed.Disclosure of Interests:Elizaveta Vasilenko: None declared, V Mazurov: None declared, Ruzana Samigullina: None declared, Anna Dadalova: None declared, Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: Pfizer, Novartis, AbbVie, JSC BIOCAD, Сelgene, MSD, Sanofi

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POS1019 INCONSISTENCY OF THE DEGREE OF CARDIOVASCULAR RISK WHEN ASSESSED USING DIFFERENT INDICES IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4311 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 777.1-777

Author(s):

E. Vasilenko ◽

A. Dadalova ◽

R. Samigullina ◽

V. Mazurov

Keyword(s):

Cardiovascular Risk ◽

Risk Evaluation ◽

Axial Spondyloarthritis ◽

Inflammatory Diseases ◽

Mean Value ◽

Low Risk ◽

Assessment Index ◽

Risk Algorithm ◽

Asas Criteria ◽

Very High

Background:Evaluation of indicators of cardiovascular risk is one of the main tasks facing a rheumatologist in the tactics of choosing a therapy for patients (pts) with axial spondyloarthritis (axSpA). It is known that pts suffering from axSpA are characterized by a significant increase in cardiovascular risk (CVR). However, there are still no recommendations regulating risk assessment scales in pts with axSpA.Objectives:were to assess the CVR in pts with axSpA and to compare different cardiovascular risk scales in these pts.Methods:The study included 55 pts at the age of 45-65 years with diagnosis of axSpA fulfilling ASAS criteria (2009) from St. Petersburg’ axSpA register. Three indices of cardiovascular risk evaluation (Systematic COronary Risk Evaluation (SCORE) with increasing coefficient 1.5 for inflammatory diseases, Reynolds Risk Score (RRS), and the third modification of QRESEARCH Cardiovascular Risk Algorithm (QRISK3) were calculated. Risk gradation: low risk (<1%), medium (1.0-4.9%), high (5.0-9.9%), very high (> 10%).Results:Mean age of the pts was 45.8±10.3 years; males - 37 (67.3%) pts, HLA-B27 positive – 34 (61.8%); mean disease duration 12.5±8.7 years. Mean value of SCORE was 2.83±1.89%, of RRS – 5.04±3.98%, of QRISK3 – 7.91±4.91%.The gradation of the degree of risk depending on the applied assessment index is presented in Table 1.IndexResultsRisk degreeSCORERRSQRISK3Low21 (38,2%)8 (14,5%)0 (0,0%)Medium26 (47,3%)23 (41,8%)17 (30,9%)High8 (14,5%)17 (30,9%)22 (40,0%)Very high0 (0,0%)7 (12,7%)16 (29,1%)Particular attention is drawn to the 100% discrepancy of low risk values when comparing SCORE and QRISK3. A similar trend persisted when comparing medium, high and very high risk. Thus, the assessment of the risks of 10-year significant cardiovascular events in pts with axSpA using the SCORE index does not coincide with the QRISK3 index data in 87.27% of cases, and with the RRS data - in 58.18% of cases. In 84.3% of cases, the mismatch between the SCORE and RRS indexes was due to the presence of an increased CRP level.Conclusion:When assessing cardiovascular risk in pts with axial spondyloarthritis, a discrepancy was found between the degrees of risk when assessed using different scales. SCORE scores were significantly different from Reynolds’ and QRISK3 scores. These features can be interrelated with a small number of factors assessed when calculating the SCORE, even though there is a correction factor for rheumatic diseases. For pts with axial spondyloarthritis, it is necessary to use additional indicators that influence cardiovascular risk, such as CRP.Disclosure of Interests:None declared.

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POS1017 CARDIOVASCULAR RISK IN DIFFERENT CLINICAL VARIANTS OF SPONDYLOARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4209 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 776.2-776

Author(s):

A. Dadalova ◽

E. Vasilenko ◽

R. Samigullina ◽

V. Mazurov

Keyword(s):

Risk Assessment ◽

New York ◽

Cardiovascular Risk ◽

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Risk Evaluation ◽

Cardiovascular Events ◽

Assessment Scales ◽

Very High ◽

Score Index

Background:Numerous studies have shown that the life expectancy of patients with spondyloarthritis (SPA) is, on average, 5-7 years less compared to the population, and the overall mortality rate is 1.6-1.9 times higher than the population, while mortality from cardiovascular disease increases by 20-40%.Objectives:of the current study were to assess the cardiovascular risk in pts with with ankylosing spondylitis, psoriatic arthritis and psoriatic spondyloarthritis and to compare different cardiovascular risk scales in these pts.Methods:The study included 54 patients with SpA aged 45 to 65 years. The patients were divided into 3 groups: patients with ankylosing spondylitis (AS) who meet the modified New York criteria for AS (1984) (n = 14), patients with psoriatic arthritis (PsA) who meet the CASPAR criteria (Classification criteria of Psoriatic Arthritis, 2006) (n = 18) and patients with psoriatic spondyloarthritis (PsSpA) meeting the modified New York criteria for AS and CASPAR criteria for PsA (n = 22).The average age in the AS group was 55.5 ± 6.43 years, in the PsA group - 57.4 ± 5.76 years, in the PsSpA group - 55.0 ± 6.45 years. Men made up 64.3% in the AC group, 50% in the PsA group, and 49% in the PsSpA group.Three indices of cardiovascular risk evaluation (Systematic COronary Risk Evaluation (SCORE) with increasing coefficient 1.5 for inflammatory diseases, Reynolds Risk Score (RRS), and the third modification of QRESEARCH Cardiovascular Risk Algorithm (QRISK3) were calculated.After the numerical assessment of the indicators, each patient was graded in the degree of CVR with the allocation of low, medium, high and very high degree. To stratify the degrees, an estimate of the total risk on the SCORE scale was used: with a value of less than 1%, the risk was considered low, from> 1% to 5% - medium or moderately increased, from> 5% to 10% - high, and> 10% - very high.Results:The values of the indices were in the AS group SCORE – 3,05±2,41%, RRS – 5,05±2,67%, QRISK3 – 6,68±3,11%, in pts with PsA SCORE - 4,11±2,22%, RRS - 5.72 ± 2.46%, QRISK3 - 7.25 ± 2.51% and in pts with PsSpA SCORE - 4.78 ± 2.65%, RRS - 6.35 ± 2.34 %, QRISK3 - 8.02 ± 3.25%.Table 1.The number of pts corresponding to different degrees of risk depending on the used CVD risk assessment scale, n = 54Degrees of riskSCORERRSQRISK3Low920Medium322616High122328Very high1310When assessing CVR using various risk assessment scales (RRS, QRISK3, SCORE), the highest values were obtained in the PsSpA group.When comparing the results obtained, it was found that the majority of the surveyed belonging to a low degree of CVR according to SCORE (9 people), when evaluated using other scales, fell into the group of medium or high risk. The assessment of the risks of 10-year significant cardiovascular events in patients with SPA using the SCORE index does not coincide with the QRISK3 index data in 70.4% of cases, with the RRS data - in 42.6% of cases, and the SCORE index shows lower values of the expected risk. The highest values were obtained when assessing CVR using the scale QRISK3.Conclusion:The highest CVR values were obtained in the PsSpA group using various risk assessment scales (RRS, QRISK3, SCORE). There was a discrepancy in the severity of CVR calculated using different rating scales in SpA patients. The largest values were obtained when using the scale QRISK3, and the smallest when calculating the CVR using the scale SCORE.References:[1]Horreau C, Pouplard C, Brenaut E, Barnetche T, Misery L, Cribier B, et al. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol 2013;27 Suppl 3:12–29.[2]Bengtsson K, Forsblad-d’Elia H, Lie E, et al. Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study. Arthritis Res Ther. 2017 May 18;19(1):102. doi: 10.1186/s13075-017-1315-zDisclosure of Interests:None declared.

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P3407Genetic predisposition and QRISK3 algorithm are promising cardiovascular risk scoring tools in young patients with axial spondyloarthritis (Bechterew's disease)

European Heart Journal ◽

10.1093/eurheartj/ehz745.0282 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

E Vasilenko ◽

A Dadalova ◽

O Nikolaeva ◽

M Korolev ◽

V Mazurov ◽

...

Keyword(s):

Cardiovascular Risk ◽

Gene Polymorphisms ◽

Axial Spondyloarthritis ◽

Young Patients ◽

Inactive Disease ◽

Major Cardiovascular Events ◽

Asas Criteria ◽

Tnf Α ◽

Risk Scoring ◽

Similar Gene

Abstract Introduction Major cardiovascular events (CVE) are frequently registered in patients with axial spondyloarthritis (axSpA) at age 35–55 years old. However, assessment of cardiovascular risk (CVR) in these age is complicated, as in pts <40 years conventional CVR scales (SCORE, ets.) are not recommended. Aim of the study To show capability of QRISK3 in assessment of CVR in young pts with axSpA and its association with gene polymorphisms, responsible for the inflammation and neoangiogenesis. Materials and methods The study included 46 pts 25–40 years old with axSpA (ASAS criteria 2009), achieved inactive disease on TNF-α inhibitors. AxSpA activity was assessed with ASDAS and BASDAI, CVR with QRISK3 (https://qrisk.org/three/). Gene polymorphisms to cytokines, responsible for inflammation and neoangiogenesis were measured (IL17A-197, IL17F7 His/Arg, IL17F-11139 c/g, TNF-863, TNF-308, TNF-238, IL1B-31, IL4–590, IL6–174, IL10–1082, IL10–592, VEGF-2578, VEGF936, MMP2–1306, MMP3–5A6A, and MMP9–1562). Results Mean age of axSpA pts was 32.5±3.87 years, 36 (78.3%) pts were male, axSpA duration 8.71±4.72 years, duration of the treatment 3.1±2.4 years, ASDAS 1.95±1.23, BASDAI 1.4±0.8, QRISK3 score 1.18±1.64%. 34 (75.6%) of the pts had a low CVR and 11 (23.9%) had increased CVR. All the patients with increased CVR had strong associations with some alleles of TNFα, IL17F and IL6, p<0.ehz745.0282 for all the correlations (table 1). Interrelations of CVR with another gene polymorphisms were not significant (R<0.25, p≥0.05, data are not present). Coefficient of correlation of QRISK3 and Gene polymorphisms (results of exploratory factor analysis with “varimax” rotation) QRISK3 IL17F-11139 CC IL17F-11139 CG IL17F7 His/His IL17F7 His/Arg IL6–174 CC IL6–174 CG TNF-308 GA TNF-308 GG 0.486 0.830 −0.830 −0.824 0.809 −0.564 0.545 0.935 −0.935 Conclusion A quarter of axSpA pts in age <40 years have an increased CVR. Similar gene polymorphisms in IL-6, IL17F, and TNF-α are strongly associated with increased CVR. QRISK3 and gene polymorphisms could be promising tools in CVR assessment in axSpA, acceptable in any age. Conflict of interests Not declared.

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Comparison of Non-radiographic Axial Spondyloarthritis and Ankylosing Spondyltis from a Single Rheumatology Hospital in Morocco

Current Rheumatology Reviews ◽

10.2174/1573397115666190222195923 ◽

2020 ◽

Vol 16 (3) ◽

pp. 240-244 ◽

Cited By ~ 2

Author(s):

Nessrine Akasbi ◽

Siar Nihad ◽

Zoukal Sofia ◽

El Kohen Khadija ◽

Harzy Taoufik

Keyword(s):

Disease Burden ◽

Axial Spondyloarthritis ◽

Univariate Analysis ◽

Cross Sectional Study ◽

Low Back ◽

New Classification ◽

Cross Sectional ◽

Asas Criteria ◽

History Of ◽

High Level

Background: According to the new classification criteria developed by The Assessment of SpondyloArthritis International Society, patients with axial spondyloarthritis (axSpA) can be classified in 2 subgroups: Patients with radiographic axial spondyloarthritis: ankylosing spondylitis patients (AS) and those with non-radiographic axial spondyloarthritis (nr-axSpA). Objective: The aim of the present study is to describe and discuss the differences and similarities between the two subgroups. Patients and Methods: A cross-sectional study was conducted in a single rheumatology hospital in Morocco. These included patients diagnosed as having axial spondyloarthritis according to ASAS criteria 2010, during a period of 6 years. The AS and the nr-axSpA subgroups were compared for the various axSpA-related variables. Results: Of the 277 patients with a diagnosis of axial SpA who were included in this study, 160 had AS and 117 had nr-axSpA. AS and nr-ax-SpA shared a similar age at diagnosis, similar prevalence of low back pain, lumbar stiffness, extra-articular manifestations, BASDAI and BASFI. In the multivariate analysis, AS patients were mainly male with cervical stiffness, enthesitis, coxitis and high level of ESR (erythrocyte sedimentation rate). The females generally had a family history of SpA and arthritis and were associated to the nr-axSpA form in the univariate analysis. Conclusion: This was the first study to characterise patients with AS and nr-axSpA in Morocco. Consistent with other studies published, this study showed that patients with nr-axSpA and patients with AS shared a comparable degree of disease burden.

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SAT0380 ENHANCING RHEUMATOLOGY REFERRALS AMONG INFLAMMATORY BOWEL DISEASE PATIENTS WITH SUSPECTED AXIAL SPONDYLOARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.576 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1138.2-1138

Author(s):

C. S. E. Lim ◽

M. Tremelling ◽

L. Hamilton ◽

A. Macgregor ◽

K. Gaffney

Keyword(s):

Back Pain ◽

Musculoskeletal Pain ◽

Chronic Back Pain ◽

Axial Spondyloarthritis ◽

Inflammatory Back Pain ◽

Aminosalicylic Acid ◽

Research Support ◽

Clinical Probability ◽

Asas Criteria ◽

History Of

Background:Axial spondyloarthritis (axSpA) is associated with inflammatory bowel disease (IBD). In IBD patients, the clinical probability of axSpA increases in those with chronic back pain (CBP) whose symptoms started before the age of forty-five years old. In practice, this should trigger a rheumatology review especially if accompanied by other symptoms suspicious of inflammatory disease. However, in any health system, the goal of identifying all possible cases need to be balanced with the practical realisation of the finite resources available.Objectives:The study aimed to define the clinical characteristics of a subgroup of IBD patients who are routinely managed in secondary care who have an increased clinical probability for axSpA. Identification of these characteristics may help improve the quality and specificity of referrals to Rheumatology from Gastroenterology clinics.Methods:An analytical cross-sectional study was undertaken. Consecutive IBD patients attending routine Gastroenterology clinics were sent a modified validated back pain questionnaire. The questionnaire included the presence or absence of a previous diagnosis of axSpA; components of validated inflammatory back pain criteria; diagrams to indicate the location of back pain and other musculoskeletal pain; personal and family history of known axSpA manifestations; and details of their IBD course, activity and treatment.IBD patients, with back pain duration > 3 months with onset before 45 years were considered to have a medium diagnostic probability (MDP) for axSpA. MDP-positive IBD patients were compared with MDP-negative IBD patients and logistic regression was used to model the association with clinical features.Results:Four hundred and seventy consecutive IBD patients (mean age 54 years; 46% male) were surveyed. Two hundred and nine patients (59%) replied, of whom 191 patients (69%) consented to participate. One hundred and seventy-three (91%) of those who consented had a valid completed questionnaire and were included for data analysis. Of these, 74% had Ulcerative Colitis and 26% had Crohn’s disease. Their mean age was 58 years, 39% male. Mean age at IBD diagnosis was 39 years, mean IBD disease duration 19 yrs. CBP (back pain greater than three months) was reported by 76%. Inflammatory back pain fulfilling Calin, Berlin, ASAS criteria was seen in 23%, 29%, and 15% respectively. In addition, 80% reported peripheral musculoskeletal pain. Self-reported personal history of enthesitis, reactive arthritis (ReA), acute anterior uveitis (AAU), skin psoriasis (PSO) and dactylitis were 50%, 30%, 24%, 15% and 0% respectively. Self-reported family history of IBD, ReA, PSO, axSpA and AAU were 60%, 36%, 22%, 11%, and 1% respectively.Ninety-one (53%) patients were MDP-positive and 82 (47%) patients were MDP-negative. The clinical characteristics associated with MDP (adjusted for age at invitation) were: the presence of inflammatory back pain using ASAS criteria [OR 8.84 (1.61,48.67); p=0.01], longer interval between symptom onset and gastroenterologist diagnosis of IBD [OR 1.09 (1.03,1.16); p=0.005], and use of rectal topical 5-aminosalicylic acid [OR 3.27 (1.11,9.68); p=0.03].Conclusion:Chronic back pain and peripheral musculoskeletal pain are common in a secondary care IBD population. In IBD patients, with back pain duration > 3 months and onset before 45 years, the presence of inflammatory back pain, longer diagnostic delay of IBD and the use of rectal topical 5-aminosalicylic acid were associated with a higher clinical probability of axSpA. The identification of these clinical features may not only improve the quality and specificity of Rheumatology referrals from Gastroenterology in this subgroup of patients but also lends real world evidence to current ASAS-endorsed recommendations for early referral of patients with a suspicion of axial spondyloarthritis.Disclosure of Interests:Chong Seng Edwin Lim Grant/research support from: AbbVie - Research support/grant but NOT for this study., Mark Tremelling: None declared, Louise Hamilton: None declared, Alexander Macgregor: None declared, Karl Gaffney Grant/research support from: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Speakers bureau: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma

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