Background Chronic inflammation is known as an independent risk factor for cardiovascular events. These include cerebrovascular disease and other neurological events. Despite this, there are only few studies focused on neurological manifestations on patients with Spondylarthritis (SpA).
Methods We performed a descriptive study of a cohort of patients with spondyloarthropathies (SpA) in biologic therapy attending to the presence of neurologic disease. Patients with spondyloarthropathies and anti-TNF treatment attending clinics at the Department of Rheumatology were analyzed to determine how many of them presented neurological events during biologic therapy. We recorder the following data: age, sex, type of SpA, age at the neurological event, HLA-B27 positivity and cardiovascular risk factors as diabetes, hypertension, and hyperlipidemia.
Results We analyzed a total of 127 patients. We found a mean age of 47.2±12.8 years with a marked male predominance of 70.1% versus 29.9% of women. The main subtype of SpA found was the peripheral pattern with a 41.7%, followed by the axial type with 40.9% and 17.3% had a mixed type of disease. With regard to treatment, all patients were with TNF blockers (etanercept 52%, infliximab 31.5%, adalimumab 13.4%, golimumab 2.4% and certolizumab 0.8%) and almost all were in DMARD therapy (96.1%). In terms of HLA-B27, 49.6% patients had a positive test, 29.1% were HLA-B27 negative and 21.3% showed lack of HLA-B27 test. Attending to cardiovascular risk factors, we found a prevalence of 42.5% of hyperlipidemia, 33.1% of hypertension, and 7.9% of type II diabetes. We found only one case of neurological events prior to biologic treatment: a case of transient ischaemic attack while the patient was in treatment with methotrexate. After starting anti-TNF treatment we recorded no cases of neurological disease.
Conclusions Although the incidence of stroke in Spanish people is unknown, some studies reported an incidence of about 80-130/100000 population and a prevalence close to 8% in people higher than 65 years. In the case of transient ischaemic attack is not well defined with a estimated prevalence higher than the stroke one. Even though the data related to people under 65 years is limited, a United States record with 7740 patients treated for stroke (1999-2008) found that up to 45% were under 65 years. In our cohort, from the beginning of biological treatment, is not observed an increase in the expected incidence of neurological events and in particular in stroke. It would be of interest to know if this is due to biological treatment or to a lack of role of chronic inflammation in this kind of vascular events. A prevalence study in SpA without biological treatment it would be interesting in the future.
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Disclosure of Interest None Declared