Cardiovascular risk factors in patients with spondyloarthritis from Northern European and Mediterranean countries: An ancillary study of the ASAS-COMOSPA project

Objectives: The objectives of this study were: (1) to compare the prevalence of cardiovascular disease and cardiovascular risk factors among different phenotypes of spondyloarthritis (SpA); (2) to assess the differences in cardiovascular disease and cardiovascular risk factors between two geographical areas, i.e. Northern Europe vs. Mediterranean region; (3) to identify potential predictive factors for high Framingham Risk Score regarding disease features in SpA and geographical area. Methods: Ancillary analysis of the international, multicentric, observational, cross-sectional ASAS-COMOSPA study. Cardiovascular disease and cardiovascular risk factors were compared depending on SpA phenotype and geographical regions. Potential factors associated with higher cardiovascular risk (i.e. Framingham Risk Score) were determined by a multiple logistic regression. Results: The most frequent cardiovascular risk factor and cardiovascular disease were smoking (31.2%) and ischemic heart disease (3.2%), respectively. Regarding SpA phenotype, axial SpA patients showed significantly lower prevalence (P < 0.05) of hypertension (19.2% vs. 33.8% vs. 26.6% for axial, peripheral and mixed phenotypes, respectively), type 2 diabetes mellitus (4.3% vs. 8.5% vs. 7.4%), dyslipidemia (13.9% vs. 28.4% vs. 15.2%) and ischemic heart disease (2.4% vs. 7.0% vs. 3.2%). Regarding geographical area, a higher frequency of hypertension (34.7% vs. 19.4%,), dyslipidemia (19.3% vs. 14.4%), obesity (29.3% vs. 20.7%) and ischemic heart disease (6.2% vs. 1.8%) was observed for Northern Europe vs. Mediterranean Region, respectively. Conclusions: Our results suggest that SpA phenotype and geographical area are associated with the prevalence of cardiovascular risk factors and the cardiovascular risk itself, observed in patients in the ASAS-COMOSPA cohort

Lipoprotein lipase activity and mass, apolipoprotein C-II mass and polymorphisms of apolipoproteins E and A5 in subjects with prior acute hypertriglyceridaemic pancreatitis

Journal Article; Research Support, Non-U.S. Gov't;BACKGROUND Severe hypertriglyceridaemia due to chylomicronemia may trigger an acute pancreatitis. However, the basic underlying mechanism is usually not well understood. We decided to analyze some proteins involved in the catabolism of triglyceride-rich lipoproteins in patients with severe hypertriglyceridaemia. METHODS Twenty-four survivors of acute hypertriglyceridaemic pancreatitis (cases) and 31 patients with severe hypertriglyceridaemia (controls) were included. Clinical and anthropometrical data, chylomicronaemia, lipoprotein profile, postheparin lipoprotein lipase mass and activity, hepatic lipase activity, apolipoprotein C II and CIII mass, apo E and A5 polymorphisms were assessed. RESULTS Only five cases were found to have LPL mass and activity deficiency, all of them thin and having the first episode in childhood. No cases had apolipoprotein CII deficiency. No significant differences were found between the non-deficient LPL cases and the controls in terms of obesity, diabetes, alcohol consumption, drug therapy, gender distribution, evidence of fasting chylomicronaemia, lipid levels, LPL activity and mass, hepatic lipase activity, CII and CIII mass or apo E polymorphisms. However, the SNP S19W of apo A5 tended to be more prevalent in cases than controls (40% vs. 23%, NS). CONCLUSION Primary defects in LPL and C-II are rare in survivors of acute hypertriglyceridaemic pancreatitis; lipase activity measurements should be restricted to those having their first episode during childhood.Part of the studies were financed by grants from the Swedish Research Council and from the King Gustaf V and Queen Victoria Research Fund and by grants from Grupos de Investigacion y Desarrollo Tecnologico de la Junta de Andalucia (Grupo consolidado CTS- 159).Ye

Factores predictores de mortalidad en pacientes hospitalizados por insuficiencia cardíaca.

Heart failure (HF) is the leading cause of hospitalization for aging populations in Western countries, and is showing an increasing mortality. The aim of this study was to assess the probable long-term mortality risk factors for patients admitted because of HF. Retrospective study of a cohort of 202 patients consecutively hospitalized because of HF and followed up for a maximum period of 5 years. Clinical and epidemiological factors and their relationship to in-hospital and long-term mortality were analyzed. In-hospital mortality was 16%.The independent predictors were: age >75 years (HR?=?2.68, 95%?IC: 1.65-4.36, p?=?0.001); cognitive impairment (HR?=?2.77, 95%?IC: 1.40-5.48, p?=?0.004); Barthel index =60 (HR?=?0.54, 95%?IC: 0.37-0.78, p?=?0,009); creatinine levels >1.16 mg/dl at admission (HR?=?1.57, 95%?IC: 1.12-2.20, p?=?0.009); and number of diagnostics >10 on discharge (HR?=?1. 64, 95%?IC: 1.14-2.36, p?=?0.007). Accumulated mortality at 12, 24, 36 and 48 months after hospital discharge were 43%, 51%, 67% and 70%, respectively; the independent predictors for this were: age >75 years (HR?=?2.55, 95%?IC: 1.56-4.15, p?75 years (HR?=?2.68, 95%?IC: 1.65-4.36, p?=?0.001); cognitive impairment (HR?=?2.77, 95%?IC: 1.40-5.48, p?=?0.004); Barthel index =60 (HR?=?0.54, 95%?IC: 0.37-0.78, p?=?0,009); creatinine levels >1.16 mg/dl at admission (HR?=?1.57, 95%?IC: 1.12-2.20, p?=?0.009); and number of diagnostics >10 on discharge (HR?=?1. 64, 95%?IC: 1.14-2.36, p?=?0.007). Accumulated mortality at 12, 24, 36 and 48 months after hospital discharge were 43%, 51%, 67% and 70%, respectively; the independent predictors for this were: age >75 years (HR?=?2.55, 95%?IC: 1.56-4.15, p?1.16 mg/dl at admission (HR?=?1.57, 95%?IC: 1.12-2.20, p?=?0.009); and number of diagnostics >10 on discharge (HR?=?1. 64, 95%?IC: 1.14-2.36, p?=?0.007). Accumulated mortality at 12, 24, 36 and 48 months after hospital discharge were 43%, 51%, 67% and 70%, respectively; the independent predictors for this were: age >75 years (HR?=?2.55, 95%?IC: 1.56-4.15, p?10 on discharge (HR?=?1. 64, 95%?IC: 1.14-2.36, p?=?0.007). Accumulated mortality at 12, 24, 36 and 48 months after hospital discharge were 43%, 51%, 67% and 70%, respectively; the independent predictors for this were: age >75 years (HR?=?2.55, 95%?IC: 1.56-4.15, p?75 years (HR?=?2.55, 95%?IC: 1.56-4.15, p?1.16 mg/dl on admission (HR?=?1.59, 95%?IC: 1.12-2.24, p?=?0.009); systolic blood pressure >140 mm Hg on admission (HR?=?0.56, 95%?IC: 0.40-0.80, p?140 mm Hg on admission (HR?=?0.56, 95%?IC: 0.40-0.80, p?10 on discharge (HR?=?1. 49, 95%?IC: 1.03-2.16, p?=?0.033). Clinical and epidemiological factors related to in-hospital and long-term mortality could help to improve the management of patients with HF

Inter-rater reliability of clinical mobility measures in ankylosing spondylitis.

Several measurements are often used in daily clinical practice in the assessment of Ankylosing Spondylitis (AS) patients. The Assessment in SpondyloArthiritis International Society (ASAS) recommend in its core set: chest expansion modified Schöber test, Occiput to wall distance, lateral lumbar flexion, cervical rotation and The Bath Ankylosing Spondylitis Metrology Index (BASMI). BASMI also includes five measurements, some of them recommended by ASAS. Three versions of BASMI have been published with different scales and intervals for each component of the index. Though studies about reliability of these measurements are needed. The aim of this study was to analyze inter-rater reliability of recommended spinal mobility measures in AS. We examined reproducibility of spinal mobility measurements on 33 AS patients performed by two experienced rheumatologists in the same day. Descriptive statistics, Intraclass Correlation Coefficients (ICC), and Smallest Detectable Difference (SDD) using the Bland-Altman criteria were obtained for all the measurements. Chest expansion showed the lowest value of ICC (0.66) and occiput-wall the highest (0.97). SDD was 2.43 units for BASMI2 and 1.27 units for BASMI10. Reliability according to ICC was moderate to high in all measurements. BASMI10, instead BASMI2, must be used: measurements used to calculate are the same but there is better reliability. Inter-rater variation, expressed as SDD, must be taken in account: smaller improvements do not demonstrate the efficacy of treatment because they can be due to experimental error and not to the treatment itself

Diagnostic delay is associated with uveitis and inflammatory bowel disease in AS: a study of extra-musculoskeletal manifestations in SpA

Objectives To examine the prevalence of extra-musculoskeletal manifestations (EMM) and the association between diagnostic delay and their incidence in ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Methods Retrospective, cohort study comprising two single centre cohorts in Europe and one multicentre cohort in Latin America (RESPONDIA). EMMs (uveitis, inflammatory bowel disease [IBD] and psoriasis) crude prevalence was calculated across geographic area and adjusted by direct standardisation. Cox proportional hazard analysis were performed to assess the association between diagnostic delay and EMM incidence. Results Of 3553 patients, 2097 had AS and 1456 had PsA. The overall prevalence of uveitis was 22.9% (95%CI 21.1–24.8) in AS and 3.8% (95%CI 2.9–5.0) in PsA; 8.1% (95%CI 7.0–9.4) and 2.1% (1.3–2.9) respectively for IBD; 11.0% (95%CI 9.7–12.4) and 94.6% (93.0–95.9) for psoriasis; with EMM often presenting before the arthritis (uveitis 45.1% and 33.3%; IBD 37.4% and 70% in AS and PsA respectively). In the multivariable model, longer diagnostic delay (≥5 years) associated with more uveitis (HR 4.01, 95%CI 3.23–4.07) and IBD events (HR 1.85, 95%CI 1.28–2.67) in AS. Diagnostic delay was not significantly associated with uveitis (HR 1.57, 95%CI 0.69–3.59) or IBD events (HR 1.59, 95%CI 0.39–6.37) in PsA. Conclusion EMMs are more prevalent in AS than PsA and often present before the onset of the articular disease. A longer diagnostic delay is associated with the “de novo” appearance of uveitis and IBD in AS, highlighting the need to enhance diagnostic strategies to shorten the time from first symptom to diagnosis in SpA