Carotid intima-media thickness and paraoxonase activity in patients with ankylosing spondylitis

Purpose: The risk of atherosclerosis is increased in several rheumatological disorders, but any such risk remains unproven for ankylosing spondylitis. Since carotid intima-media thickness is an indicator of early atherosclerosis, and the paraoxonase (PON1) enzyme has antioxidant activity to prevent LDL oxidation, we aimed to identify: 1) the relationship between carotid intima-media thickness (CIMT) and serum paraoxonase (PON1) activity in ankylosing spondylitis (AS) patients; and 2) the possible differences in CIMT in AS patients versus age-matched, healthy controls. Methods: Forty-five AS patients (36.8±9.8 years, 36 males, 9 females) and 30 controls (35.9±10.2 years, 23 males, 7 females) were recruited consecutively. Serum PON1 activity and CIMT were measured. The Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Radiologic Index (BASRI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were used to identify relationships between these clinical indices and levels of CIMT and PON1. Results: Mean CIMT was significantly increased in AS patients relative to controls (0.49±0.06 mm vs. 0.59±0.07 mm; p < 0.0001). Conversely, serum PON1 activity was decreased (199.1±60.3 U/L vs. 96.7±29 U/L; p < 0.0001). PON1 activity was negatively correlated with CIMT (r = -0.557, p = 0.0001). Disease duration was positively correlated with CIMT (r = 0.542, p = 0.0001) and negatively correlated with PON1 (r = -0.649, p = 0.0001). On multivariate analysis, disease duration and serum PON1 activity were found to be independent predictors of CIMT (R2 = 0.687, p = 0.0001). Conclusions: In conclusion, significantly increased CIMT and decreased PON1 activity suggest a relationship between atherosclerosis and AS: a relationship that is strongly correlated with disease duration.

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Assessment of Subclinical Vascular Disease Associated with Ankylosing Spondylitis

The Journal of Rheumatology ◽

10.3899/jrheum.100668 ◽

2011 ◽

Vol 38 (4) ◽

pp. 723-729 ◽

Cited By ~ 61

Author(s):

NÓRA BODNÁR ◽

GYÖRGY KEREKES ◽

ILDIKÓ SERES ◽

GYÖRGY PARAGH ◽

JÁNOS KAPPELMAYER ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Vascular Disease ◽

Aortic Stiffness ◽

Disease Duration ◽

Activity Index ◽

Disease Activity Index ◽

Intima Media Thickness ◽

Diagnostic Tools ◽

Spine Mobility

Objective.Studies indicate that ankylosing spondylitis (AS), as well as rheumatoid arthritis, may be associated with accelerated atherosclerosis and vascular disease. We assessed endothelial dysfunction, carotid atherosclerosis, and aortic stiffness in AS in context with clinical and laboratory measurements.Methods.Forty-three patients with AS and 40 matched healthy controls were studied. We assessed common carotid intima-media thickness (ccIMT), flow-mediated vasodilation (FMD), and pulse-wave velocity (PWV) in association with age, disease duration, smoking habits, body mass index, patient’s assessment of pain and disease activity, Bath AS Disease Activity Index, Bath AS Functional Index (BASFI), metric measurements, erythrocyte sedimentation rate, C-reactive protein, and HLA-B27 status.Results.We found impaired FMD (6.85 ± 2.98% vs 8.30 ± 3.96%; p = 0.005), increased ccIMT (0.65 ± 0.15 vs 0.54 ± 0.15 mm; p = 0.01), and higher PWV (8.64 ± 2.44 vs 8.00 ± 1.46 m/s; p = 0.03) in patients with AS compared to controls, respectively. We also found that ccIMT negatively correlated with FMD (r = −0.563; p = 0.0001) and positively correlated with PWV (r = 0.374; p = 0.018). Both ccIMT and PWV correlated with disease duration (r = 0.559; p = 0.013 and r = 0.520; p = 0.022, respectively), BASFI (r = 0.691; p = 0.003 and r = 0.654; p = 0.006), decreased lumbar spine mobility (r = −0.656; p = 0.006 and r = −0.604; p = 0.013), chest expansion (r = −0.502; p = 0.047 and r = −0.613; p = 0.012), and increased wall-occiput distance (r = 0.509; p = 0.044 and r = 0.614; p = 0.011).Conclusion.In this well characterized AS population, impaired FMD and increased ccIMT and PWV indicate abnormal endothelial function and increased atherosclerosis and aortic stiffness, respectively. The value of noninvasive diagnostic tools needs to be further characterized.

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Evaluation of serum endothelial cell-specific molecule-1 levels and carotid intima-media thickness in patients with ankylosing spondylitis / Ankilozan spodilitli hastalarda serum endothelial cell-specific molecule-1 ve karotis intima media kalınlığının değerlendirilmesi

Turkish Journal of Biochemistry ◽

10.1515/tjb-2016-0004 ◽

2016 ◽

Vol 41 (1) ◽

Author(s):

Hakan Türkön ◽

Ferhat Gökmen ◽

Sema Uysal ◽

Ayla Akbal ◽

Beşir Şahin İnceer ◽

...

Keyword(s):

Endothelial Cell ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Activity Index ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Chronic Inflammatory Disease ◽

Control Group ◽

Media Thickness ◽

Significant Difference

AbstractObjective: Ankylosing spondylitis (AS) is a chronic inflammatory disease and the increased mortality in these patients is largely caused by cardiovascular diseases. Endothelial cell-specific molecule-1 (ESM-1) is a novel marker to assess endothelial dysfunction and expressed by the vascular endothelium. In this study, the serum ESM-1 levels in patients with AS and the possible association between serum ESM-1 and carotid intima-media thickness (CIMT) as a marker of atherosclerosis was evaluated.Methods: A total of thirty-seven patients with AS and thirty healthy control subjects were included in this study. ESM-1, erythrocyte sedimentation rate(ESR),C-reactive protein (CRP) and CIMT were measured in all subjects. ESM-1 levels were measured by ELISA method. The disease activity of patients with AS were assessed using questionnaires Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).Results: Serum ESM-1 levels were lower in AS patients than in healthy controls. However, there was no statistically significant difference between ESM-1 levels (304.3±185.2 vs. 373.9±206.9 ng/L, respectively; p=0.064). Patients with AS had significantly higher CIMT levels compared with controls (0.77±0.16 vs. 0.53±0.09 mm, respectively; p<0.001). While a statistically significant positive correlation was detected in all subjects between CIMT levels and ESR, CRP (r=0.378, p=0.002, r=0.547, p<0.001, respectively), no significant correlation was detected between serum ESM-1 levels and ESR, CRP, BASDAI, BASFI and CIMT.Conclusion: The results showed that CIMT values in AS patients were increased when compared to control group. There was no correlation among ESM-1 levels, disease activity and CIMT. In order to reveal the pathological role of the ESM-1 levels in patients with AS need more studies.

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Carotid intima-media thickness in spondyloarthritis patients

Sao Paulo Medical Journal ◽

10.1590/s1516-31802013000100020 ◽

2013 ◽

Vol 131 (2) ◽

pp. 100-105 ◽

Cited By ~ 9

Author(s):

Thelma Larocca Skare ◽

Guilherme Cortez Verceze ◽

André Augusto de Oliveira ◽

Sonia Perreto

Keyword(s):

Ankylosing Spondylitis ◽

Inflammatory Markers ◽

Activity Index ◽

Subclinical Atherosclerosis ◽

Univariate Analysis ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

University Hospital ◽

Clinical Parameters ◽

Media Thickness

CONTEXT AND OBJECTIVE Accelerated atherosclerosis has become a major problem in rheumatic inflammatory disease. The aim here was to analyze carotid intima-media thickness (IMT) in spondyloarthritis (SpA) patients and correlate this with clinical parameters and inflammatory markers. DESIGN AND SETTING Cross-sectional analytical study at Rheumatology Outpatient Clinic, Evangelical University Hospital, Curitiba. METHODS IMTs (measured using Doppler ultrasonography) of 36 SpA patients were compared with controls. The IMT in SpA patients was associated with inflammatory markers, like erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); and with clinical parameters, like axial or peripheral involvement, dactylitis, HLA B27, uveitis occurrence, Bath Ankylosing Spondylitis Functional Index (BASFI) and lipid profile. RESULTS The mean IMT in SpA patients was 0.72 ± 0.21 mm; in controls, 0.57 ± 0.13 mm (P = 0.0007). There were no associations with ESR, CRP, BASDAI or clinical data. In univariate analysis, greater IMT was seen in patients with longer disease duration (P = 0.014; Pearson R = 0.40; 95% confidence interval, CI = 0.06 to 0.65); higher triglycerides (P = 0.02; Spearman R = 0.37; 95% CI = 0.03 to 0.64); and older age (P = 0.0014; Pearson R 0.51; 95% CI = 0.21 to 0.72). CONCLUSION SpA patients have a higher degree of subclinical atherosclerosis than in controls, thus supporting clinical evidence of increased cardiovascular risk in rheumatic patients.

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Carotid Intima Media Thickness as a Marker of Atherosclerosis in Ankylosing Spondylitis

International Journal of Rheumatology ◽

10.1155/2014/839135 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 13

Author(s):

Naveen Gupta ◽

Renu Saigal ◽

Laxmikant Goyal ◽

Abhishek Agrawal ◽

Rajat Bhargava ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Activity Index ◽

Surrogate Marker ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Study Groups ◽

Control Group ◽

Media Thickness ◽

Cardiovascular Morbidity And Mortality

Aim. Increased cardiovascular morbidity and mortality have been observed in ankylosing spondylitis because of accelerated atherosclerosis. We measured carotid intima media thickness (CIMT) as a surrogate marker of atherosclerosis in this study.Methods. In this study 37 cases of AS and the same number of matched individuals were recruited. CIMT measurements were done using B-mode ultrasound. Disease activity was assessed using Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), and Bath ankylosing spondylitis metrological index (BASMI) scores and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels.Results. Mean age of the study groups was 29.43 ± 9.00 years. Average disease duration was 65.62 ± 54.92 months. Twenty-eight (75.68%) of cases were HLA B-27 positive. A significantly increased CIMT was observed in cases as compared to control group (0.62 ± 0.12 versus 0.54 ± 0.04;P<0.001). CIMT in the cases group positively correlated with age(r=0.357; P<0.05), duration of disease(r=0.549; P<0.01), and BASMI(r=0.337; P<0.05)and negatively correlated with ESR(r=−0.295; P<0.05).Conclusions. Patients of AS had a higher CIMT than those of the control group. CIMT correlated with disease chronicity.

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AB0258 CAROTID INTIMA-MEDIA THICKNESS AND SERUM BIOMARKERS IN PARAGUAYAN PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6520 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1428.2-1428

Author(s):

V. Valinotti ◽

A. Paats ◽

R. Acosta ◽

L. Roman ◽

I. Acosta-Colman ◽

...

Keyword(s):

Cardiovascular Risk ◽

Disease Duration ◽

Subclinical Atherosclerosis ◽

High Sensitivity ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Serum Biomarkers ◽

Carotid Plaques ◽

Media Thickness ◽

Hs Crp

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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The Minimum Clinically Important Improvement and Patient-acceptable Symptom State in the BASDAI and BASFI for Patients with Ankylosing Spondylitis

The Journal of Rheumatology ◽

10.3899/jrheum.151244 ◽

2016 ◽

Vol 43 (9) ◽

pp. 1680-1686 ◽

Cited By ~ 15

Author(s):

Milla Johanna Kviatkovsky ◽

Sofia Ramiro ◽

Robert Landewé ◽

Maxime Dougados ◽

Florence Tubach ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Disease Duration ◽

Activity Index ◽

Disease Activity Index ◽

Nonsteroidal Antiinflammatory Drugs ◽

Cumulative Distribution ◽

Antiinflammatory Drugs ◽

Important Improvement ◽

Patient Acceptable Symptom State ◽

Active Disease

Objective.To establish cutoffs for the minimum clinically important improvement (MCII) and the patient-acceptable symptom state (PASS) for the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) in patients with ankylosing spondylitis (AS).Methods.Patients with AS who started nonsteroidal antiinflammatory drugs were included. After 4 weeks, the PASS and the MCII were defined using external anchor questions (for the PASS, patients considering their condition of AS over the prior 48 h as “acceptable” forever; and for the MCII, those reporting moderate or slightly important improvement). Consistency of the MCII and PASS were tested according to HLA-B27 status, presence/absence of SpA extraarticular manifestations, age, sex, disease duration, and baseline BASDAI/BASFI score. The 75th percentile of the cumulative distribution was used to determine the MCII and PASS.Results.In total, 283 patients from a multinational cohort were included. Overall cutoffs for the PASS were 4.1 in the BASDAI and 3.8 in the BASFI. Cutoffs for the MCII were 0.7 and 0.4 for the BASDAI and BASFI, respectively. Subgroup analyses revealed that disease duration and baseline BASDAI/BASFI were significantly associated with the PASS and MCII. In a subanalysis limited to patients with active disease (baseline BASDAI ≥ 4), the MCII was 1.1 for the BASDAI and 0.6 for the BASFI.Conclusion.The conceptual viability of the PASS for the BASDAI is questionable because levels approach those required for the start of biological therapy. Because the MCII is less variable than the PASS, we propose its exclusive use, with cutoffs of 1.1/0.6 for the BASDAI/BASFI in patients with active disease. Because these values are based on a subset of the study population, we recommend confirmation in larger studies focused on patients with baseline BASDAI ≥ 4.

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