Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Av. de Valdecilla, 25, 39008 Santander, Cantabria, Spain.
Semin Arthritis Rheum. 2021 Apr;51(2):395-403. doi: 10.1016/j.semarthrit.2021.02.003. Epub 2021 Feb 13.
To compare the atherosclerosis disease burden between ankylosing spondylitis (AS) and non-radiographic (nr) axial spondyloarthritis (axSpA) and establish a model that allows to identify high-cardiovascular (CV) risk in axial spondyloarthritis patients.
Cross-sectional study from the AtheSpAin cohort, a Spanish multicenter cohort aimed to study atherosclerosis in axSpA. Carotid ultrasound (US) was performed to determine the carotid intima-media wall thickness (cIMT) and detect the presence of carotid plaques. The European cardiovascular disease risk assessment model, the Systematic COronary Risk Evaluation (SCORE), was also applied.
A set of 639 patients with AS and 167 patients with nr-axSpA without history of CV events were recruited. AS patients were older showing more CV risk factors and higher values of C reactive protein and erythrocyte sedimentation rate (ESR) than those with nr-axSpA. However, no difference in the prevalence of carotid plaques or in the cIMT was found between both groups in the adjusted analysis. The percentage of patients reclassified from the low and moderate CV risk categories to the very high-risk category due to the presence of carotid plaques was comparable in AS and nr-axSpA (10.7% versus 10.1% and 40.5% versus 45.5%, respectively). A model containing age, BASFI and ESR applied to moderate risk axSpA patients identified 41% of these patients as having very high-risk patients with high specificity (88%).
The atherosclerosis burden is similar in nr-axSpA and AS. As occurred for AS, more than 40% of axSpA patients included in the category of moderate CV risk according to the SCORE are reclassified into very high risk after carotid US, and a clinically relevant proportion of them can be detected by applying a model containing age, BASFI and ESR.
比较强直性脊柱炎（AS）和非放射学（nr）轴性脊柱关节炎（axSpA）之间的动脉粥样硬化疾病负担，并建立一种能够识别轴性脊柱关节炎患者心血管（CV）高风险的模型。
这是一项来自 AtheSpAin 队列的横断面研究，该队列是一个西班牙多中心队列，旨在研究 axSpA 中的动脉粥样硬化。通过颈动脉超声（US）来确定颈动脉内膜中层厚度（cIMT）并检测颈动脉斑块的存在。还应用了欧洲心血管疾病风险评估模型，即系统性冠状动脉风险评估（SCORE）。
共纳入了 639 例 AS 患者和 167 例无 CV 事件史的 nr-axSpA 患者。AS 患者年龄较大，具有更多的 CV 危险因素，且 C 反应蛋白和红细胞沉降率（ESR）值高于 nr-axSpA 患者。然而，在调整分析中，两组之间颈动脉斑块的患病率或 cIMT 均无差异。由于存在颈动脉斑块，从低危和中危 CV 风险类别重新分类为极高危类别的患者百分比在 AS 和 nr-axSpA 中相似（10.7%对 10.1%和 40.5%对 45.5%）。应用于中危 axSpA 患者的包含年龄、BASFI 和 ESR 的模型可识别出 41%的患者为极高危患者，特异性为 88%。
nr-axSpA 和 AS 之间的动脉粥样硬化负担相似。与 AS 一样，根据 SCORE 分类为中危 CV 风险的 axSpA 患者中有超过 40%在进行颈动脉 US 后重新分类为极高危，通过应用包含年龄、BASFI 和 ESR 的模型可以检测到其中相当一部分患者。
