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Rheumatology Advance Access published online on June 4, 2008
Rheumatology, doi:10.1093/rheumatology/ken198
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Trend towards increased arterial stiffness or intima–media thickness in ankylosing spondylitis patients without clinically evident cardiovascular disease

S. Mathieu1,2, H. Joly2,3, G. Baron4, A. Tournadre1,2, J.-J. Dubost1,2, J.-M. Ristori1,2, J.-R. Lusson2,3 and M. Soubrier1,2

1Rheumatology department, G. Montpied Teaching Hospital, 2Faculty of Medicine, Clermont 1 University, 3Cardiology department, G. Montpied Teaching Hospital, Clermont-Ferrand and 4Epidemiology, Biostatistics and Clinical Research department, Bichat Hospital, Paris, France.

Correspondence to: S. Mathieu, Service de Rhumatologie, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France. E-mail: smathieu11{at}yahoo.fr


  Abstract

Objectives. Increased incidence of cardiovascular disease (CVD) has been observed in AS. The reasons of this increase are not fully understood (greater prevalence of traditional cardiovascular risks, consequences of treatment (NSAID) or biological inflammation). The objectives of this study are to assess intima–media thickness (IMT) and arterial stiffness (i.e augmentation index AIx), markers of sub-clinical atherosclerosis in AS patients and to examine the effects of TNF-{alpha} inhibitors on arterial stiffness in active AS patients.

Methods. Sixty AS patients were enrolled with 60 healthy controls. Their BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and BASFI (Bath Ankylosing Spondylitis Functional Index) scores, ESR and CRP levels were recorded. Subclinical atherosclerosis was assessed by measurement of AIx by pulse wave analysis and IMT by carotid echography.

Results. We found significantly increased IMT in the AS group compared with healthy controls. After adjustment for confounding factors, an underlying trend towards increased IMT was still present (P = 0.06). No difference was found in arterial stiffness between the two groups. AS patients, treated or not with anti-TNF-{alpha} at baseline, had significantly increased IMT and AIx or a trend towards increase. IMT was positively correlated with tobacco use, WHR and blood pressure but not correlated with CRP level. Despite improvement in markers of disease activity, arterial stiffness was unchanged after 14 weeks of treatment with TNF antagonists.

Conclusion. This study shows a trend towards increased subclinical atherosclerosis in AS patients. TNF-{alpha} blockade does not seem to improve arterial stiffness in AS patients, but our results lack statistical power.

KEY WORDS: Ankylosing spondylitis, Intima–media thickness, Arterial stiffness, Tumour necrosis factor-{alpha} inhibitors

Submitted 1 November 2007; Accepted 15 April 2008


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