Persistence of C-reactive protein increased levels and high disease activity are predictors of cardiovascular disease in patients with axial spondyloarthritis

Navarini, Luca; Currado, Damiano; Marino, Annalisa; Donato, Stefano Di; Biaggi, Alice; Caso, Francesco; Costa, Luisa; Tasso, Marco; Ruscitti, Piero; Pavlych, Viktoriya; Berardicurti, Onorina; Ciancio, A.; Pantano, Ilenia; Camarda, Federica; Chimenti, Maria Sole; D’Antonio, Arianna; Ursini, F.; Corrado, Addolorata; Cantatore, Francesco Paolo; Perricone, Roberto; Guggino, Giuliana; Ciccia, Francesco; Cipriani, Paola; Scarpa, Raffaele; Afeltra, Antonella; Giacomelli, Roberto

doi:10.1038/s41598-022-11640-8

Cited by 15 publications

(10 citation statements)

References 31 publications

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“…Of note, 40% of patients had to be reclassified to high-risk patients after plaques were recognized in carotid ultrasound [ 23 ]. In contrast, CV events are indeed associated with persisting elevation of CRP through clinical visits [ 25 ]. Also, radiographic progression of the spine is accompanied by raised markers of subclinical atherosclerosis [ 26 ].…”

Section: Resultsmentioning

confidence: 99%

Cardiovascular risk in axial spondyloarthritis—a systematic review

Hintenberger,

Affenzeller,

Vladychuk

et al. 2023

Clin Rheumatol

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Cardiovascular manifestations are common in patients suffering axial spondyloarthritis and can result in substantial morbidity and disease burden. To give an overview of this important aspect of axial spondyloarthritis, we conducted a systematic literature search of all articles published between January 2000 and 25 May 2023 on cardiovascular manifestations. Using PubMed and SCOPUS, 123 out of 6792 articles were identified and included in this review. Non-radiographic axial spondyloarthritis seems to be underrepresented in studies; thus, more evidence for ankylosing spondylitis exists. All in all, we found some traditional risk factors that led to higher cardiovascular disease burden or major cardiovascular events. These specific risk factors seem to be more aggressive in patients with spondyloarthropathies and have a strong connection to high or long-standing disease activity. Since disease activity is a major driver of morbidity, diagnostic, therapeutic, and lifestyle interventions are crucial for better outcomes. Key Points• Several studies on axial spondyloarthritis and associated cardiovascular diseases have been conducted in the last few years addressing risk stratification of these patients including artificial intelligence.• Recent data suggest distinct manifestations of cardiovascular disease entities among men and women which the treating physician needs to be aware of.• Rheumatologists need to screen axial spondyloarthritis patients for emerging cardiovascular disease and should aim at reducing traditional risk factors like hyperlipidemia, hypertension, and smoking as well as disease activity.

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Section: Resultsmentioning

confidence: 99%

Cardiovascular risk in axial spondyloarthritis—a systematic review

Hintenberger,

Affenzeller,

Vladychuk

et al. 2023

Clin Rheumatol

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“…On the other hand, in contrast to our data, treatment persistence in that registry study was higher in bDMARD naïve (87%) than in previously TNFi-treated patients (68%). Another Italian study of 34 PsA patients treated with ustekinumab after failure or inadequate response to csDMARDs or TNFi reported achievement of MDA -in 70.5% of subjects at month 24 (24), and maintenance of low or minimal disease activity status has been recently shown to have a great influence on patients' quality of life and perception of their clinical condition (27).…”

Section: Discussionmentioning

confidence: 99%

Persistence, effectiveness and safety of ustekinumab compared to TNF inhibitors in psoriatic arthritis within the Italian PsABio cohort

Gremese

Ciccia

Selmi

et al. 2022

Clinical and Experimental Rheumatology

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Objective. To compare real-world persistence, effectiveness and tolerability of ustekinumab versus TNF inhibitors (TNFi) in psoriatic arthritis (PsA).Methods. One-year data from Italian subjects enrolled in the PsABio study (PsA patients receiving 1st-to 3rd-line treatment with ustekinumab or TNFi) were evaluated.Treatment persistence was analysed using Kaplan-Meier curves; hazard ratios (HR) of stopping treatment, and the corresponding 95% confidence intervals (CI), were computed through Cox regression models. Proportions of patients reaching clinical effectiveness endpoints were analysed using logistic regression, including propensity score (PS) adjustment for imbalanced baseline covariates, and non-response imputation if treatment was stopped/switched.Results. Among 222 participants with follow-up data (effectiveness set), 101 received ustekinumab and 121 TNFi. In the ustekinumab group, 74.3% continued treatment up to 12±3 months compared to 63.6% in the TNFi group. Ustekinumab showed better persistence than TNFi, overall and in specific subgroups (females, monotherapy without methotrexate, BMI <25 or >30 kg/m 2 , patients receiving ustekinumab as 2nd-line treatment instead of a second TNFi). Overall, the PS-adjusted HR of treatment discontinuation was 0.46 (95% CI: 0.26-0.82) for ustekinumab vs TNFi. cDAPSA LDA/remission was achieved in 43.5% of ustekinumab and 43.6% of TNFi-treated patients, while MDA was achieved in 24.2% and 28.0% of patients, respectively. After PS adjustment, odds ratios of clinical effectiveness did not differ significantly. Both treatments showed an acceptable safety profile.5 Conclusion. This prospective, real-life study found a better persistence of ustekinumab than TNFi in PsA patients. At 1 year, both treatments showed similar effectiveness.

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“…A multicenter study from Spain found that CRP > 3 mg/L and ESR at the time of diagnosis were significantly associated with CIMT, a surrogate marker of atherosclerosis [81]. Another study from Italy showed that the persistence of increased CRP levels and high disease activity (BASDAI > 4 or ASDAS > 2.1) are associated with increased CVD [82].…”

Section: Inflammation and (Subclinical) Cardiovascular Diseasementioning

confidence: 99%

Cardiovascular Disease and Cardiac Imaging in Inflammatory Arthritis

Madenidou

Mavrogeni

Nikiphorou

2023

Life

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Cardiovascular morbidity and mortality are more prevalent in inflammatory arthritis (IA) compared to the general population. Recognizing the importance of addressing this issue, the European League Against Rheumatism (EULAR) published guidelines on cardiovascular disease (CVD) risk management in IA in 2016, with plans to update going forward based on the latest emerging evidence. Herein we review the latest evidence on cardiovascular disease in IA, taking a focus on rheumatoid arthritis, psoriatic arthritis, and axial spondylarthritis, reflecting on the scale of the problem and imaging modalities to identify disease. Evidence demonstrates that both traditional CVD factors and inflammation contribute to the higher CVD burden. Whereas CVD has decreased with the newer anti-rheumatic treatments currently available, CVD continues to remain an important comorbidity in IA patients calling for prompt screening and management of CVD and related risk factors. Non-invasive cardiovascular imaging has been attracting much attention in view of the possibility of detecting cardiovascular lesions in IA accurately and promptly, even at the pre-clinical stage. We reflect on imaging modalities to screen for CVD in IA and on the important role of rheumatologists and cardiologists working closely together.

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Persistence of C-reactive protein increased levels and high disease activity are predictors of cardiovascular disease in patients with axial spondyloarthritis

Cited by 15 publications

References 31 publications

Cardiovascular risk in axial spondyloarthritis—a systematic review

Cardiovascular risk in axial spondyloarthritis—a systematic review

Persistence, effectiveness and safety of ustekinumab compared to TNF inhibitors in psoriatic arthritis within the Italian PsABio cohort

Cardiovascular Disease and Cardiac Imaging in Inflammatory Arthritis

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