Background Ankylosing spondylitis (AS) is a systemic inflammatory disorder that causes axial and peripheral arthritis with extraarticular features1. Increased mortality is largely attributable to cardiovascular disease (CVD) that has been found as 20%>40% 2 due to many risk factors driven by systemic inflammatory mediators3.
Objectives Is to assess presence of atherosclerosis in Egyptian patients with AS and its relation to disease duration and disease activity.
Methods This study included 60 subjects divided into 2 groups; Group I: 30 patients with AS diagnosed according to the modified New York criteria1984 aged ≥18 years. Group II: 30 age and sex matched healthy controls. Patients with heart failure, diabetes mellitus, obesity BMI >30, were excluded. All the subjects were subjected to detailed medical history, clinical examination. Assessment of AS disease activity was done using: BASDAI, BASMI and BASFI. Laboratory investigations included CBC, ESR, CRP titre, lipid profile (Total cholesterol, TG, LDL, HDL), liver and kidney function tests, vWF Ag level in serum by ELISA. ECG, common carotid arterial duplex and dobutamine echocardiography were done for patients only. All the results were subjected to statistical analysis.
Results 11 patients (37%) had active AS; 3 of them (27%) were on Anti-TNF blockers treatment and 8 (73%) were not. 19 patients (63%) had inactive disease; 6 of them (32%) were on Anti-TNF blockers treatment and 13 (68%) were not. By carotid duplex, 3 patients (10%) had increased intimal medial thickness (IMT) while 27 patients (90%) were normal. Dobutamine echo showed hypertensive response in 8 cases (26.7%); 6 (75%) of them had active disease while 2 (25%) had inactive disease and it was normal in 22 cases (73.3%). There was significant increase in the level of vWF in actively diseased patients than inactive patients than control group (p<0.05). IMT was significantly increased in AS patients than the control group (p<0.05). AS patients receiving Anti-TNF blocker had a significantly higher LDL (p<0.05). In the inactive group, vWF and IMT were significantly increased in patients receiving biological treatment (p<0.05). Hypertensive response shows significant increase in active than inactive AS patients (p<0.05). There was positive correlation between vWF level and BASDI, BASMI, BASFI scores, fatigue, peripheral arthritis, enthesitis, morning stiffness and IMT and hypertensive response showed positive correlation with BASDI, BASFI scores and morning stiffness.
Conclusions vWF, as a marker of atherosclerosis in AS patients, was positively correlated with disease activity scores and IMT. AS patients receiving Anti-TNF blocker had a significantly higher LDL. In the inactive group, vWF and IMT were significantly increased in patients receiving biological treatment.
Yuan SM (2009): Cardiovascular involvement in ankylosing spondylitis. Vascular; 17: 342-54.
Lautermann D and Braun J (2002): Ankylosing spondylitis – cardiac manifestations. Clin Exp Rheumatol; 20 suppl: s11-s15.
Divecha H, Sattar N, Rurnley A, et al., (2005): Cardiovascular risk parameters in patients with ankylosing spondylitis in comparison with non inflammatory control subjects: relevance of systemic inflammation. Clin Sci; 109: 171-6.
Disclosure of Interest None Declared
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