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Dear Editor,We read the article "Carotid intima-media thickness (cIMT) in spondyloarthritis patients" by Skare et al. 1 They aimed to investigate cIMT in spondyloarthritis patients and correlate this with clinical parameters and inflammatory markers. They concluded that spondyloarthritis patients have a higher degree of subclinical atherosclerosis than controls, thus supporting clinical evidence of increased cardiovascular risk in rheumatic patients. We believe that these findings will be guides for further studies about subclinical atherosclerosis on cIMT inpatients with spondyloarthritis.Carotid intima-media thickness is a widely accepted marker for subclinical atherosclerosis. Increased cIMT is a common indicator of atherosclerotic involvement of the vascular structure, thereby indicating coronary artery disease, cerebrovascular disease and peripheral arterial disease. cIMT has received increased attention due to its role as an independent prognostic factor for hypertension, chronic kidney disease, diabetes and systemic inflammatory diseases such as systemic lupus erythematosus, Behçet and psoriasis. 3 It is a non-invasive method for assessing endothelial dysfunction in clinical practice. Previous reports have suggested that cIMT is a useful sonographic marker for early atherosclerosis. Hence, cIMT assessment can be used to document regression or progression of atherosclerosis, and it can be used to make correlations with other inflammatory markers.Chronic obstructive pulmonary disease (COPD) and atherosclerosis may occur due to similar risk factors, and may be significant causes of morbidity and mortality. Obstructive sleep apnea is associated with elevated risk of cardiovascular events. The risks of early atherosclerosis and cardiovascular events in adults with COPD are higher, independent of risk factors. cIMT shows direct proportionality with age and inverse proportionality with FEV1%, and is a non-invasive, easily applicable and cheap method that can be used in determining the risk of atherosclerosis. In conclusion, although cIMT is a novel, simple, inexpensive and noninvasive method for evaluating endothelial dysfunction and subclinical atherosclerosis in clinical practice, it may be affected by many conditions. Therefore, without other inflammatory markers, cIMT alone may not provide information to clinicians about the prognosis in patients with spondyloarthritis.

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