Arida Aikaterini, Protogerou Athanasios D, Konstantonis George, Konsta Maria, Delicha Evi M, Kitas George D, Sfikakis Petros P
From the Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital; Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School, Athens, Greece.A. Arida, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; A.D. Protogerou, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G. Konstantonis, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; M. Konsta, MD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; E.M. Delicha, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G.D. Kitas, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; P.P. Sfikakis, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School.
J Rheumatol. 2015 Nov;42(11):2098-105. doi: 10.3899/jrheum.150316. Epub 2015 Oct 1.
Chronic inflammatory rheumatic diseases are associated with accelerated atherosclerosis, but data in ankylosing spondylitis (AS) are limited and the relative contribution of inflammation versus classical cardiovascular (CV) risk factors remains a matter of controversy. We addressed this in an original study and a metaanalysis of previous studies.
Atheromatic plaques in carotid and femoral arteries, carotid hypertrophy [intima-media thickness (IMT), cross-sectional area], and carotid stiffness by ultrasound, as well as aortic stiffness by pulse wave velocity, were examined in consecutive nondiabetic, CV disease (CVD)-free patients with AS. Healthy individuals carefully matched 1:1 with patients for age, sex, smoking habits, hyperlipidemia, and hypertension served as controls. A metaanalysis of original studies that examined subclinical atherosclerosis in patients with AS versus controls with comparable CVD risk factors was also performed.
Carotid and femoral atheromatic plaques were slightly less prevalent compared with controls in a contemporary cohort consisting of 67 patients with AS (82% men), aged 47.5 ± 12.5 years (mean ± SD), with a median disease duration of 12 years and a Bath AS Disease Activity Index (BASDAI) of 1.8 (interquartile range 0.4-3.6), of whom 66% were receiving anti-tumor necrosis factor (TNF) treatment. Carotid hypertrophy and stiffness, as well as aortic stiffness, were similar between patients and their matched controls. Metaanalysis of all published studies revealed a significantly increased carotid IMT, but not plaque burden, in AS versus controls. Notably, however, increased IMT was not evident in studies involving patients with low disease activity (mean BASDAI < 4) or in those studies that included > 50% of patients treated with anti-TNF.
Low AS disease activity is not associated with accelerated atherosclerosis.
慢性炎症性风湿性疾病与动脉粥样硬化加速有关，但强直性脊柱炎（AS）方面的数据有限，炎症与经典心血管（CV）危险因素的相对贡献仍存在争议。我们通过一项原创研究和对既往研究的荟萃分析来解决这一问题。
对连续的非糖尿病、无心血管疾病（CVD）的AS患者进行颈动脉和股动脉的动脉粥样硬化斑块、颈动脉肥厚[内膜中层厚度（IMT）、横截面积]、通过超声检测的颈动脉僵硬度以及通过脉搏波速度检测的主动脉僵硬度的检查。年龄、性别、吸烟习惯、高脂血症和高血压与患者1:1仔细匹配的健康个体作为对照。还对研究AS患者与具有可比CVD危险因素的对照者亚临床动脉粥样硬化的原创研究进行了荟萃分析。
在一个当代队列中，67例AS患者（82%为男性），年龄47.5±12.5岁（均值±标准差），疾病中位病程为12年，巴斯强直性脊柱炎疾病活动指数（BASDAI）为1.8（四分位间距0.4 - 3.6），其中66%正在接受抗肿瘤坏死因子（TNF）治疗，与对照组相比，颈动脉和股动脉粥样硬化斑块的患病率略低。患者与其匹配对照之间的颈动脉肥厚和僵硬度以及主动脉僵硬度相似。对所有已发表研究的荟萃分析显示，与对照组相比，AS患者的颈动脉IMT显著增加，但斑块负荷未增加。然而，值得注意的是，在疾病活动度低（平均BASDAI<4）的患者研究中或在超过50%的患者接受抗TNF治疗的研究中，IMT增加并不明显。
低AS疾病活动度与动脉粥样硬化加速无关。
