Law Lucy, Lindqvist Per, Liv Per, Hellman Urban, Lejon Kristina, Geijer Mats, Söderberg Stefan, Forsblad-d'Elia Helena
Department of Public Health and Clinical Medicine, Unit of Medicine, Umeå University, Umeå, Sweden.
Department of Surgical and Perioperative Sciences, Clinical Physiology, Umeå University, Umeå, Sweden.
Clin Rheumatol. 2024 May;43(5):1559-1570. doi: 10.1007/s10067-024-06913-8. Epub 2024 Mar 6.
There is an increased risk for cardiovascular disease (CVD) in patients with radiographic axial spondyloarthritis (r-axSpA). In this cross-sectional study, we aimed to, overall and stratified by sex, (i) compare ultrasound derived carotid intima media thickness (cIMT), between patients and controls, and (ii) investigate associations between cIMT, clinical disease activity and inflammation-related laboratory markers in patients with r-axSpA.
In total, 155 patients diagnosed with r-axSpA using the modified New York criteria and 400 controls were included. Bilateral carotid ultrasound, laboratory testing, and questionaries were acquired. Disease-specific assessments were carried out for patients. Linear regression analysis was used to assess associations.
Linear regression analyses showed that patients with r-axSpA had increased mean cIMT compared to controls (mean ± SD, 0.8 ± 0.1 mm vs 0.7± 0.1 mm, respectively, unstandardized β (95% CI) -0.076 (-0.10, -0.052), P < 0.001) adjusted for smoking status and age. Linear regression analyses for patients with r-axSpA showed that only males presented significant associations between cIMT and inflammation-related laboratory markers, white blood cell (WBC) count (mean ± SD, 6.8 ± 1.6 10/L) and monocytes (0.6 ± 0.2 10/L); WBC count (unstandardized β (95% CI) 0.019 (0.0065, 0.031), P = 0.003, R = 0.57) and monocytes (0.13 (0.0047, 0.26), P = 0.041, R = 0.55), adjusted for age, smoking status, body mass index, hypertension, dyslipidemia, diabetes mellitus, ASDAS-CRP, and treatment with DMARDs and glucocorticoids. No significant association was found between cIMT and clinical disease activity assessed by ASDAS-CRP.
Patients with r-axSpA had significantly increased cIMT compared to controls. In male patients, higher WBC and monocyte count were associated with an increase in cIMT suggesting the role of inflammation in the development of atherosclerosis. Key Points •Carotid intima-media thickness was increased in patients with radiographic axial spondyloarthritis compared to controls. •White blood cell and monocyte counts were associated with carotid intima-media thickness in male patients with radiographic axial spondyloarthritis.
影像学轴向脊柱关节炎（r-axSpA）患者患心血管疾病（CVD）的风险增加。在这项横断面研究中，我们旨在总体上以及按性别分层，（i）比较患者与对照组之间超声测量的颈动脉内膜中层厚度（cIMT），以及（ii）研究r-axSpA患者中cIMT、临床疾病活动度和炎症相关实验室指标之间的关联。
总共纳入了155例根据改良纽约标准诊断为r-axSpA的患者和400名对照。进行了双侧颈动脉超声检查、实验室检测和问卷调查。对患者进行了疾病特异性评估。采用线性回归分析来评估关联。
线性回归分析显示，与对照组相比，r-axSpA患者的平均cIMT增加（均值±标准差，分别为0.8±0.1mm和0.7±0.1mm，未标准化β（95%CI）-0.076（-0.10，-0.052），P<0.001），对吸烟状况和年龄进行了校正。对r-axSpA患者的线性回归分析显示，仅男性患者的cIMT与炎症相关实验室指标、白细胞（WBC）计数（均值±标准差，6.8±1.6×10⁹/L）和单核细胞（0.6±0.2×10⁹/L）之间存在显著关联；校正年龄、吸烟状况、体重指数、高血压、血脂异常、糖尿病、ASDAS-CRP以及使用DMARDs和糖皮质激素治疗后，WBC计数（未标准化β（95%CI）0.019（0.0065，0.031），P=0.003，R=0.57）和单核细胞（0.13（0.0047，0.26），P=0.041，R=0.55）。未发现cIMT与通过ASDAS-CRP评估的临床疾病活动度之间存在显著关联。
与对照组相比，r-axSpA患者的cIMT显著增加。在男性患者中，较高的WBC和单核细胞计数与cIMT增加相关，提示炎症在动脉粥样硬化发展中的作用。要点•与对照组相比，影像学轴向脊柱关节炎患者的颈动脉内膜中层厚度增加。•白细胞和单核细胞计数与影像学轴向脊柱关节炎男性患者的颈动脉内膜中层厚度相关。
