Subclinical atherosclertoic disease in ankylosing spondylitis and non-radiographic axial spondyloarthritis. A multicenter study with 806 patients.

Inigo Gonzalez-Mazon¹, Javier Rueda-Gotor², Ivan Ferraz-Amaro³, Lara Sanchez-Bilbao⁴, David Martinez-Lopez⁵, Fernanda Genre⁶, Natalia Palmou Fontana⁷, Vanesa Calvo-Río², Sara Remuzgo-Martínez⁶, Veronica Pulito-Cueto⁶, Alfonso Corrales⁸, Leticia Lera-Gómez⁶, Virginia Portilla⁶, Cristina Mata⁹, Vanesa Hernández-Hernández¹⁰, Santos Castañeda¹¹, Esther Francisca Vicente-Rabaneda¹², C Fernandez-Carballido¹³, M Paz Martínez-Vidal¹⁴, David Castro-Corredor¹⁵, Joaquín Anino-Fernández¹⁵, Juan Carlos Quevedo-Abeledo¹⁶, Carlos Rodríguez-Lozano¹⁷, María Luz García Vivar,¹⁸, Eva Galínez-Agirregoikoa¹⁸, C. Fernandez-Diaz¹⁹, Javier Llorca²⁰, Raquel López-Mejías⁶, Esther Montes-Perez²¹, Diana Peiteado²², Chamaida Plasencia²³, Alejandro Balsa-Criado²⁴, Nuria Barbarroja²⁵, Lourdes Ladehesa-Pineda²⁶, Rafaela Ortega-Castro²⁷, Eduardo Collantes-Estévez²⁶, Ricardo Blanco²⁸ and Miguel Ángel González-Gay²⁹, ¹Hospital Universitario Marques de Valdecilla, Bezana, Spain, ²H.U. Marques de Valdecilla, Santander, Spain, ³Division of Rheumatology. Hospital Universitario de Canarias. Spain., Santa Cruz de Tenerife, Spain, ⁴Hospital Universitario Marques de Valdecilla, Santander, Spain, ⁵Hospital Universitario Marques de Valdecilla, Santander (SPAIN), Spain, ⁶Research group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic bone Diseases of the Musculoskeletal System, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain, ⁷UNIVERSITARY HOSPITAL MARQUES VALDECILLA, Santander, Spain, ⁸Research group on genetic epidemiology and atherosclerosis in systemic diseases and in metabolic bone diseases of the musculoskeletal system, IDIVAL; and Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain, ⁹Hospital de Laredo, Santander, Spain, ¹⁰Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain, ¹¹Princesa University Hospital, Universidad Autónoma, Madrid, Madrid, Spain, ¹²Hospital Universitario de la Princesa, IIS-Princesa, UAM, Madrid, Madrid, Spain, ¹³H San Juan, Alicante, Spain, ¹⁴Hospital General Universitario de Alicante, Alicante, Spain, ¹⁵Hospital General Universitario de Ciudad Real, Ciudad Real, Spain, ¹⁶Hospital Dr. Negrín, Las Palmas de Gran Canaria, Spain, ¹⁷Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain, ¹⁸Hospital Universitario Basurto, Bilbao, Spain, ¹⁹H. Marqués de Valdecilla, Madrid, Spain, ²⁰School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain, ²¹Diagnóstico Médico Cantabria (DMC), Santander, Spain, ²²Hospital Universitario La Paz-IdiPaz, Madrid, Spain, ²³Rheumatology, La Paz University Hospital-IdiPAZ, madrid, Spain, ²⁴HOSPITAL UNIVERSITARIO LA PAZ, madrid, Spain, ²⁵Rheumatology Department, Reina Sofia University Hospital/ Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC)/ University of Cordoba, Cordoba, Spain, Cordoba, Spain, ²⁶Rheumatology Department, Reina Sofia University Hospital/ Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC)/ University of Cordoba, Cordoba, Spain, Córdoba, Spain, ²⁷Hospital Universitario Reina Sofía, Córdoba, Spain, ²⁸Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain, ²⁹Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain

Meeting: ACR Convergence 2020

Keywords: Atherosclerosis, Cardiovascular, Carotid Artery Disease, spondyloarthritis, Subclinical Cardiovascular Disease

Session Information

Date: Sunday, November 8, 2020

Title: Spondyloarthritis Including Psoriatic Arthritis – Diagnosis, Manifestations, & Outcomes Poster II: Extra-MSK & Comorbidities

Session Type: Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Cardiovascular (CV) mortality and morbidity is increased in ankylosing spondylitits (AS) as compared to the general population. Carotid plaque, considered as a surrogate marker for atherosclerosis associated with very high CV risk, is more prevalent in AS patients than in healthy controls. Nevertherless, we have no consistent data about subclinical atherosclerosis (SA) in non-radiographic axial spondyloarthritis (nr-axSpA). In this study we assessed the SA in nr-axspA compared with AS in the largest series studied so far, and established a predictive model to identify patients with high CV risk.

Methods: This is a transversal observational study from the AtheSpAin cohort, a Spanish multicenter cohort to study atherosclerosis in axSpA. We compared patients with AS vs those with nr-axSpA according to ASAS criteria. Carotid ultrasound (US) examination was done in all patients, included the measurement of carotid intima-media wall thickness (cIMT) in the common carotid artery and the detection of plaques in the extracranial carotid tree bilaterally, according to the Mannhein consensus. CV risk was calculated according to the systematic coronary risk evaluation (SCORE).

Results: A set of 639 patients with AS and 167 patients with nr-axSpA were recruited in this study. Patients with AS were mainly men, older and had a higher prevalence of cardiovascular risk factors compared to nr-axSpA patients. They also had higher levels of C reactive protein and estimated (CPR) and erythrocyte sedimentation rate (ESR). Comparison of baseline characteristics and clinical features between patients with AS and nr-axSpA is shown in table 1. After adjusting data for age, sex and cardiovascular morbidity, no difference in the prevalence of carotid plaques or in the carotid IMT was found between both groups.

We then analyzed the prevalence of carotid plaques in the groups of low and moderate CV risk according to the SCORE, finding no differences between AS and nr-axSpA (10.7 % Vs 10.1%, p=0.9 and 40.5 % Vs 45.5 %,p=0.94 respectively)

Considering the comparable atherosclerotic burden observed in nr-axSpA and AS, we designed a model to identify those patients diagnosed with any of these conditions with very high CV risk because of the presence of carotid plaques. A predictive model which included SCORE plus age, BASFI and ESR at time of disease diagnosis in patients with moderate SCORE showed a high specifity (88%) to detect very high risk patients, but with a limited sensitivity (41%) table 2. The AUC of this model was found to have higher discrimination than the SCORE AUC ( 0.652 Vs 0.592, p= 0,025).

Conclusion: SA disease in patients with nr-axSp is similar to those with AS, despite the higher inflammatory state of the latter. Many patients with axSpA with a moderate risk of CV events according to the SCORE are reclassified into very high risk after carotid US examination. Patients with higher age, ESR at the diagnosis of axSpA and BASFI are more likely to present carotid plaques in US examination.

Data represent means ± SD or median (IQR) when data were not normally distributed. BMI: body mass index; LDL: low-density lipoprotein; HDL: high-density lipoprotein; CRP: C reactive protein. ASDAS-CRP (Ankylosing Spondylitis Disease Activity Score) categories were defined as: disease activity < 1.3 inactivity; ≥ 1.3 to < 2.1 low disease activity; ≥ 2.1 to < 3.5 high disease activity; ≥ 3.5 very high. NSAID: Nonsteroidal anti-inflammatory drugs; DMARD: disease-modifying antirheumatic drug. TNF: tumor necrosis factor; Obesity: BMI >30 kg/m2. BASFI: Bath Ankylosing Spondylitis Functional Index; BASMI Bath Ankylosing Spondylitis Metrology Index. BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; MASES: Maastricht Ankylosing Spondylitis Enthesitis Score. Significants ‘p’ are depicted in bold. *Adjusted for age, sex and CV comorbidity

Values in bold face are statistically significant. AIC: Akaike information criterion; BIC: Schwarz Bayesian criterion AUC: area under the curve; pfitHL: Hosmer-Lemeshow goodness-of-fit DMARD: disease-modifying antirheumatic drug; BASMI Bath Ankylosing Spondylitis Metrology Index.

Disclosure: I. Gonzalez-Mazon, None; J. Rueda-Gotor, None; I. Ferraz-Amaro, None; L. Sanchez-Bilbao, None; D. Martinez-Lopez, Lilly, 2; F. Genre, None; N. Palmou Fontana, None; V. Calvo-Río, None; S. Remuzgo-Martínez, None; V. Pulito-Cueto, None; A. Corrales, None; L. Lera-Gómez, None; V. Portilla, None; C. Mata, None; V. Hernández-Hernández, None; S. Castañeda, Roche, 2; E. Vicente-Rabaneda, Roche, 8, BMS, 2, 8; C. Fernandez-Carballido, None; M. Martínez-Vidal, None; D. Castro-Corredor, None; J. Anino-Fernández, None; J. Quevedo-Abeledo, None; C. Rodríguez-Lozano, None; M. García Vivar,, None; E. Galínez-Agirregoikoa, None; C. Fernandez-Diaz, None; J. Llorca, None; R. López-Mejías, None; E. Montes-Perez, None; D. Peiteado, None; C. Plasencia, None; A. Balsa-Criado, None; N. Barbarroja, None; L. Ladehesa-Pineda, None; R. Ortega-Castro, None; E. Collantes-Estévez, None; R. Blanco, AbbVie, 2, 5, 8, MSD, 2, 5, 8, Roche, 2, 5, 8, Pfizer, 5, 8, Bristol-Myers Squibb, 5, 8, Janssen, 5, 8, Eli Lilly, 5, 8, UCB Pharma, 5, 8; M. González-Gay, None.

To cite this abstract in AMA style:

Gonzalez-Mazon I, Rueda-Gotor J, Ferraz-Amaro I, Sanchez-Bilbao L, Martinez-Lopez D, Genre F, Palmou Fontana N, Calvo-Río V, Remuzgo-Martínez S, Pulito-Cueto V, Corrales A, Lera-Gómez L, Portilla V, Mata C, Hernández-Hernández V, Castañeda S, Vicente-Rabaneda E, Fernandez-Carballido C, Martínez-Vidal M, Castro-Corredor D, Anino-Fernández J, Quevedo-Abeledo J, Rodríguez-Lozano C, García Vivar, M, Galínez-Agirregoikoa E, Fernandez-Diaz C, Llorca J, López-Mejías R, Montes-Perez E, Peiteado D, Plasencia C, Balsa-Criado A, Barbarroja N, Ladehesa-Pineda L, Ortega-Castro R, Collantes-Estévez E, Blanco R, González-Gay M. Subclinical atherosclertoic disease in ankylosing spondylitis and non-radiographic axial spondyloarthritis. A multicenter study with 806 patients. [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/subclinical-atherosclertoic-disease-in-ankylosing-spondylitis-and-non-radiographic-axial-spondyloarthritis-a-multicenter-study-with-806-patients/. Accessed .

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