Cardiovascular risk in patients with spondyloarthritis

U chorych na spondyloaratropatie zapalne, w porównaniu z populacją ogólną, obserwuje się większą częstość występowania chorób układu sercowo-naczyniowego. Zwiększone ryzyko sercowo-naczyniowe ma związek nie tylko z tradycyjnymi czynnikami ryzyka sercowo-naczyniowego, ale również z czynnikami niekonwencjonalnymi, zależnymi od aktywności przewlekłej choroby zapalnej. Celem pracy jest przedstawienie dostępnych obecnie wyników obserwacji i badań, wskazujących na wpływ różnych czynników na ryzyko sercowo-naczyniowe u chorych na spondyloartropatie zapalne oraz możliwość wielokierunkowego działania profilaktycznego lub terapeutycznego, czego efektem powinna być poprawa rokowania chorych.Patients with spondyloarthritis have a higher prevalence of cardiovascular diseases compared to the general population. Increased cardiovascular risk is not only related to traditional cardiovascular risk factors but also to unconventional factors that depend on chronic inflammatory disease activity. This study aims to present currently available observation and research findings indicating the impact of various factors on cardiovascular risk in patients with spondyloarthritis and the possibility of multifaceted preventive or therapeutic action, which should result in an improved prognosis of patients

Antidiabetic effect of disease-modifying antirheumatic drugs

Leki modyfikujące przebieg choroby stanowią podstawę leczenia przewlekłych zapaleń stawów, hamują postęp choroby i mogą doprowadzić do stanu remisji. Większość z tych leków to preparaty o działaniu immunosupresyjnym oraz leki biologiczne. Pojawiają się doniesienia o dodatkowych, oprócz efektu przeciwzapalnego, działaniach tych preparatów, w tym o działaniu przeciwcukrzycowym. Celem pracy jest przedstawienie dostępnych obecnie wyników badań i obserwacji klinicznych, wskazujących na możliwość wielokierunkowego działania leków modyfikujących przebieg choroby, szczególnie efektu redukującego ryzyko rozwoju cukrzycy i zależnych od niej powikłań.Disease-modifying antirheumatic drugs (DMARDs) form the mainstay of treatment for chronic arthritis, slow down progression of the disease and can lead to a state of remission. Most of these drugs are immunosuppressive preparations and biologics. There are reports on effects of these preparations in addition to their anti-inflammatory effect, including antidiabetic effect. This paper aims to present the currently available results of studies and clinical observations indicating the potential for multidirectional effects of DMARDs, particularly a risk-reducing effect on the development of diabetes and diabetes-dependent complications

Metabolic Syndrome and Rheumatoid Arthritis Activity: An Analysis of Clinical, Laboratory, and Ultrasound Parameters

(1) Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease associated with an increased incidence of metabolic syndrome (MetS). The aim of this study was to determine if there is an association between MetS and parameters of RA activity, as well as between metabolic parameters and indices of RA activity. (2) Methods: This study involved 65 patients with RA. MetS was diagnosed according to the 2009 IDF/AHA/NHLBI criteria. The comparative analysis was conducted between RA patients with MetS (RA (MetS (+)) and without MetS (RA (MetS (−)). The activity of RA was assessed using clinical, laboratory, and ultrasound (US) parameters. (3) Results: Compared with RA MetS (−) patients, RA MetS (+) patients were characterized by higher disease activity, according to Disease Activity Score (DAS28), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI). RA MetS (+) patients had significantly higher tender and swollen joint counts, and values of erythrocyte sedimentation rate, C-reactive protein, and US parameters (grey-scale (GSUS), power Doppler (PDUS)). Significant correlations were found between metabolic parameters (waist circumference, cholesterol and glucose concentrations) and indices of RA activity. (4) Conclusion: The results of this study show that, in patients with RA, the presence of MetS is associated with higher disease activity, based on several clinical, laboratory, and US parameters

Gender Differences in Cardiovascular Risk Profile in Rheumatoid Arthritis Patients with Low Disease Activity

Objective. Patients with rheumatoid arthritis (RA) have an excess risk of cardiovascular (CV) disease (CVD). The objective of the study was to compare CV risk profile in female and male RA patients with low disease activity. Materials and Methods. The study group consisted of 70 RA patients with continuous low disease activity and no CVD (54 women, 16 men) and 33 healthy controls of comparable age. The groups were assessed for blood pressure, serum amino-terminal pro-brain natriuretic peptide (NT-proBNP), carotid intima media thickness (cIMT), electrocardiography, ejection fraction (EF), and diastolic dysfunction (DD). Results. Significantly higher burden of atherosclerosis, as revealed by higher cIMT, was found in males [0.93 (0.2) mm] vs females [0.80 (0.2) mm]. The risk of 10-year CVD was significantly higher in men than in women with RA. High/very high risk of fatal CVD was found in 62.5% of male patients. Males were significantly more often current/ex-smokers and had lower HDL-cholesterol and higher atherogenic index. There were no significant differences in NT-proBNP, QTc duration, and parameters of EF and DD. Conclusions. In RA patients with continued low disease activity, a higher burden of atherosclerosis was found in males than in females. The data suggest a significant impact of traditional CV risk factors

The Relationship between Hematological Markers of Systemic Inflammation (Neutrophil-To-Lymphocyte, Platelet-To-Lymphocyte, Lymphocyte-To-Monocyte Ratios) and Ultrasound Disease Activity Parameters in Patients with Rheumatoid Arthritis

Background: An accurate measurement of disease activity is essential for the appropriate management of a patient with rheumatoid arthritis (RA). Hematological markers of systemic inflammation (Neutrophil-to-Lymphocyte (NLR), Platelet-to-Lymphocyte (PLR) and Lymphocyte-to-Monocyte (LMR) ratios) are reported to be novel, sensitive measures of inflammatory response, in addition to conventional markers (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Disease Activity Score (DAS28)). The goal of the study was to assess the relationship of NLR, PLR, and LMR with ultrasonography (US) parameters of disease activity in RA patients. Methods: The study group consisted of 126 consecutive RA patients (100 women, 26 men). The following assessments were performed: joint counts, DAS28, complete blood cell counts, ESR, CRP, and US of 24 small joints. Results: NLR and PLR were significantly positively correlated with all US parameters of disease activity (Grey Scale US, Power Doppler US, and Global scores). The mean values of NLR and PLR were significantly higher in patients with poor prognostic factors: moderate/high vs. low disease activity (NLR: p < 0.001; PLR: p = 0.007), anti-CCP positive vs. anti-CCP negative (NLR: p = 0.01; PLR: p = 0.006). In multiple regression tests, significant correlations were confirmed for: NLR and DAS28 (p = 0.04), and CRP (p = 0.001); PLR and Power Doppler US (p = 0.04), and ESR (p = 0.02). No correlation was found for LMR. Conclusion: NLR and PLR are associated with US disease activity parameters and may serve as reliable, inexpensive markers, with prognostic significance in RA