Patients With Ankylosing Spondylitis Have Increased Cardiovascular and Cerebrovascular Mortality: A Population-Based Study
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Patients With Ankylosing Spondylitis Have Increased Cardiovascular and Cerebrovascular Mortality: A Population-Based Study. Ann Intern Med.2015;163:409-416. [Epub 15 September 2015]. doi:10.7326/M14-2470
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Patients with ankylosing spondylitis should periodically be screened for both overt and subclinical atherosclerotic cardiovascular diseases and preventive statin therapy may be considered
Ankylosing spondylitis is a genetically predisposed, chronic-inflammatory disease associated with increased pro-inflammatory cytokines; TNF-alpha, TGF-beta and IL-1. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) may be elevated but normal CRP and ESR do not rule out the diagnosis of AS [3].
AS is associated with increase in blood pressure and dyslipidemia may lead to congestive heart failure and peripheral arterial disease [4]. Carotid intima media thickness (CIMT), a marker of subclinical atherosclerosis can be found in significant number of patients with AS [5][6].
Since AS is a life-long disease, along with NSAIDs, DMARDs, physiotherapy and or biologic, periodic cardiovascular risk assessment and statin therapy is required [7].
References:
1. Nisha Nigil Haroon, MD, DM, DNB, MSc; J. Michael Paterson, MSc; Ping Li, PhD; Robert D. Inman, MD; and Nigil Haroon, MD, PhD, DM. Patients With Ankylosing Spondylitis Have Increased Cardiovascular and Cerebrovascular Mortality: A Population-based Study. Ann Intern Med. Published online 11 August 2015
2. Schoenfeld SR, Lu L, Rai SK, Seeger JD, Zhang Y, Choi HK. Statin use and mortality in rheumatoid arthritis: a general population-based cohort study. Ann Rheum Dis. 2015 Aug 5
3. Spoorenberg A, van der Heijde D, de Klerk E, et al. Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol. 1999;26:980-984
4. Han C, Robinson DW Jr, Hackett MV, Paramore LC, Fraeman KH, Bala MV. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol. 2006; 33: 2167–2172
5. Gonzalez-Gay MA, Gonzalez-Juanatey C, Piñeiro A, et al. High-grade C-reactive protein elevation correlates with accelerated atherogenesis in patients with rheumatoid arthritis. J Rheumatol. 2005;32(7):1219-23.
6. Carotid intima-media thickness in spondyloarthritis patients. Sao Paulo Med. J. vol.131 no.2 São Paulo 2013
7. Van Denderen, J C et al. “Statin Therapy Might Be Beneficial for Patients with Ankylosing Spondylitis.” Annals of the Rheumatic Diseases 65.5 (2006): 695–696. PMC. Web. 31 Aug. 2015.