scholarly journals Potential relation of cardiovascular risk factors to disease activity in patients with axial spondyloarthritis

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110337
Author(s):  
Iván Ferraz-Amaro ◽  
Javier Rueda-Gotor ◽  
Fernanda Genre ◽  
Alfonso Corrales ◽  
Ricardo Blanco ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Axial Spondyloarthritis ◽  
Multivariable Analysis ◽  
Activity Score ◽  
Increased Risk ◽  
Activity Measurements ◽  
Beta Coefficient

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.

Abstract T P136: Potential Contributors to the Declining Impact of Stroke Risk Factors with Age: Implications for Stroke Epidemiology in the Elderly

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
George Howard ◽  
Mary Cushman ◽  
Maciej Banach ◽  
Brett M Kissela ◽  
David C Goff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Stroke Risk ◽  
Multivariable Analysis ◽  
The Elderly ◽  
Stroke Risk Factors ◽  
Age Related ◽  
Increased Risk ◽  
The Impact ◽  
Age Related Changes

Purpose: The importance of stroke research in the elderly is increasing as America is “graying.” For most risk factors for most diseases (including stroke), the magnitude of association with incident events decreases at older ages. Potential changes in the impact of risk factors could be a “true” effect, or could be due to methodological issues such as age-related changes in residual confounding. Methods: REGARDS followed 27,748 stroke-free participants age 45 and over for an average of 5.3 years, during which 715 incident strokes occurred. The association of the “Framingham” risk factors (hypertension [HTN], diabetes, smoking, AFib, LVH and heart disease) with incident stroke risk was assessed in age strata of 45-64 (Young), 65-74 (Middle), and 75+ (Old). For those with and without an “index” risk factor (e.g., HTN), the average number of “other” risk factors was calculated. Results: With the exception of AFib, there was a monotonic decrease in the magnitude of the impact across the age strata, with HTN, diabetes, smoking and LVH even becoming non-significant in the elderly (Figure 1). However, for most factors, the increasing prevalence of other risk factors with age impacts primarily those with the index risk factor absent (Figure 2, example HTN as the “index” risk factor). Discussion: The impact of stroke risk factors substantially declined at older ages. However, this decrease is partially attributable to increases in the prevalence of other risk factors among those without the index risk factor, as there was little change in the prevalence of other risk factors in those with the index risk factor. Hence, the impact of the index risk factor is attenuated by increased risk in the comparison group. If this phenomenon is active with latent risk factors, estimates from multivariable analysis will also decrease with age. A deeper understanding of age-related changes in the impact of risk factors is needed.

Assessment of Preclinical Atherosclerosis in Patients with Ankylosing Spondylitis

2012 ◽  
Vol 39 (2) ◽  
pp. 322-326 ◽  
Author(s):  
WAFA HAMDI ◽  
MOUNA CHELLI BOUAZIZ ◽  
IMEN ZOUCH ◽  
MOHAMED MEHDI GHANNOUCHI ◽  
MANEL HAOUEL ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Structural Damage ◽  
Activity Index ◽  
Age At Onset ◽  
Disease Activity Index ◽  
Mobility Limitations ◽  
Increased Risk ◽  
Preclinical Atherosclerosis

Objective.Epidemiological studies recently confirmed the increased risk of vascular morbidity and mortality during ankylosing spondylitis (AS). Increase of intima-media thickness (IMT) of the common carotid artery is a useful and noninvasive marker of preclinical atherosclerosis. The aim of our study was to compare IMT in patients with AS with matched controls and to determine risk factors of atherosclerosis related to AS.Methods.We performed a prospective study of 60 consecutive patients meeting modified New York criteria for AS, compared to 60 controls matched for age and sex. Disease-specific measures were determined. Measurement of IMT was performed by the same radiologist using the same machine and probe in right and left common carotid arteries, and the average of the 2 measurements was considered.Results.In total 48 male and 12 female patients were recruited, and 60 corresponding controls; mean age was 36 ± 11 years. We found significantly increased IMT in the AS group (0.51 ± 0.12 mm) compared with controls (0.39 ± 0.09 mm; p = 0.001). After adjustment for confounding factors, increased IMT was still present (p = 0.003). Age at onset of AS (p = 0.001), Bath AS Disease Activity Index (p = 0.002), AS Disease Activity Score (ASDAS) erythrocyte sedimentation rate (ESR; p = 0.047), ASDAS C-reactive protein (CRP; p = 0.012), Bath AS Functional Index (p = 0.008), global spine visual analog scale for pain (p = 0.000), Schober index (p = 0.039), Bath AS Metrology Index (p = 0.028), modified Stoke Ankylosing Spondylitis Spine Score (p = 0.035), and high ESR (p = 0.001) and CRP (p = 0.000) were correlated with high IMT in patients with AS. Otherwise, status of arthritis (p = 0.442), enthesitis (p = 0.482), and HLA-B27 (p = 0.528) seemed to have no effect on IMT.Conclusion.AS is associated with an increased risk of atherosclerosis independent of traditional risk factors. Disease activity, functional and mobility limitations, structural damage, and inflammation are the most incriminated risk factors.

scholarly journals Rapid improvement in spinal pain in patients with axial spondyloarthritis treated with secukinumab: primary results from a randomized controlled phase-IIIb trial

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110514
Author(s):  
Denis Poddubnyy ◽  
Effie Pournara ◽  
Agnieszka Zielińska ◽  
Asta Baranauskaite ◽  
Alejandro Muñoz Jiménez ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Pain Score ◽  
Axial Spondyloarthritis ◽  
Activity Index ◽  
Spinal Pain ◽  
Rapid Improvement ◽  
Activity Measurements ◽  
Group A ◽  
Group B

Background: This study aimed to evaluate the efficacy and safety of secukinumab 150 mg compared with placebo in the management of spinal pain and disease activity in patients with axial spondyloarthritis (axSpA) at Week 8 and up to Week 24. Methods: Patients ( n = 380) with active axSpA were randomized (3:1) to secukinumab 150 mg (Group A) or placebo (Group B). At Week 8, patients from Group A with an average spinal pain score <4 were defined as responders and were re-assigned to secukinumab 150 mg (Arm A1); whereas non-responders were re-randomized to secukinumab 150/300 mg (Arm A2/A3). Patients from Group B were re-randomized (1:1) to secukinumab 150/300 mg (Arm B1/B2). Results: At Week 8, the odds of achieving an average spinal pain score of <4 were significantly higher for patients on secukinumab 150 mg than for patients on placebo (odds ratio (OR): 1.89; 95% confidence interval (CI): 1.08–3.33; p = 0.0264). Further reductions in spinal pain were observed across treatment groups up to Week 24. Pronounced improvements were also observed in other disease activity measurements, such as Bath Ankylosing Spondylitis Disease Activity Index and Ankylosing Spondylitis Disease Activity Score. Responders from Group A showed the highest improvements for all measured parameters of spinal pain compared with the other arms. No new or unexpected safety signals were observed. Conclusion: Secukinumab provided rapid and significant improvement in spinal pain at Week 8 which was sustained or increased further up to Week 24 in patients with axSpA. Trial Registration: ClinicalTrials.gov: NCT03136861. Registered May 2, 2017.

scholarly journals POS1039 PSORIATIC ARTHRITIS AND PHYSICAL ACTIVITY, A SYSTEMATIC REVIEW

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 793-794
Author(s):  
J. Kessler ◽  
M. Chouk ◽  
T. Ruban ◽  
C. Prati ◽  
D. Wendling ◽  
...  
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Clinical Trials ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Well Being ◽  
Activity Score ◽  
Beneficial Effects ◽  
Increased Risk

Background:The beneficial effects of physical activity (PA) have been demonstrated in rheumatoid arthritis and ankylosing spondylitis on disease and co-morbidities while they are not clearly established in psoriatic arthritis.Objectives:Thus, the aim of this study was, on the basis of a systematic review of the literature, (i) to assess the level of physical activity in these patients and (ii) to determine the effects of physical activity on joint and extra articular symptoms and on well-being.Methods:The research strategy was performed on Pubmed, Cochrane,and PEDro databases using the following keywords: “psoriatic arthritis AND physical activity” without restriction. Articles published in English before October 2019 were identified and selected according to the PRISMA methodology by two independent investigators. In case of disagreement, a third investigator was interviewed. To be included in the qualitative synthesis, the studies had to meet the PICOS criteria.Results:Among the 259 studies identified, 13 were finally included. 241 were excluded because they did not address the topic or were not in English and 5 were duplicated. Two epidemiological studies revealed that 17 and 68 % of patients comply with WHO recommendations for the general population in terms of physical activity. The main explanations expressed by patients are; a lack of promotion of physical activity by the rheumatologist and the fear of pain during the movement also called “kinesiophobia”. Among the three prospective randomized clinical trials, one of them showed a significant 20% reduction in the BASDAI (Bath Ankylosing Spondylitis Disease) and a 25% reduction in pain. Fatigue was significantly reduced by 15% following a physical activity protocol on a cyclergometer for 11 weeks. Muscle strength and maximum VO2 were significantly improved after participation in the physical activity protocol in two of the clinical trials. Four retrospective studies evaluated the effect of physical activity on the risk of enthesitis or dactylitis. None were associated with an increased risk of enthesitis. However, physical activity was found to be a risk factor for structural remodelling of the Achilles tendon. And, avoiding physical activity seems to be a protective factor against the risk of enthesitis. On the other hand, the three clinical trials did not mention any increase in the disease’s activity score. Finally, the effects of four rehabilitation programs have been evaluated in psoriatic arthritis and other inflammatory rheumatism. The beneficial effects were modest and concerned the reduction of pain for all the programs and of fatigue for two of the programs.Conclusion:The studies showed a beneficial effect of physical activity on disease activity, on well-being and on comorbidities. The data on the risk of enthesitis are reassuring. Further investigations are necessary to confirm these results and to precise the modalities of exercise.Table 1.PICOS criteria according to PRISMA methodology.ParticipantsAdults > 18 years old,Psoriatic Arthritis defined to CASPAR classification criteria (2006) or Moll Wright criteria (1973)InterventionAny type of physical activity regardless of intensity and durationComparisonControl group (not mandatory)OutcomesLevel of physical activityDisease activity scoreComorbiditiesStudy designNo restrictionDisclosure of Interests:None declared.

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