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BACKGROUND: Group of spondyloarthritis include not only damage of musculoskeletal system, oftenly it’s combination with a variety of comorbid pathologies, primarily involving the cardiovascular system, is characteristic. Given the high importance of early detection, assessment and further prediction of the risks of cardiovascular diseases in this cohort of patients, a competent interpretation of the risks of aggravating cardiovascular diseases and their prevention is one of the priority tasks not only for rheumatologists, but also for specialists in related fields. AIM: To study the structure of comorbid pathology and assess the frequency of cardiovascular diseases in patients with ankylosing spondylitis, psoriatic arthritis and psoriatic spondyloarthritis, to conduct a comparative analysis of the incidence of cardiovascular comorbidities in different groups of spondyloarthritis. MATERIALS AND METHODS: The study included 153 patients with a verified diagnosis of spondyloarthritis. Patients were divided into 3 groups depending on the nature of the lesion of the musculoskeletal system: ankylosing spondylitis meeting the modified New York criteria for ankylosing spondylitis (1984) (n = 53), psoriatic arthritis meeting the CASPAR criteria (Classification criteria of Psoriatic Arthritis, 2006) (n = 40) and psoriatic spondylitis simultaneously meeting the modified New York criteria for ankylosing spondylitis and the CASPAR criteria for psoriatic arthritis (n = 60). All patients taken with monoclonal antibodies (inhibitors TNF-alpha). RESULTS: When studying cardiovascular comorbidity in patients with spondyloarthritis in three groups, arterial hypertension was most common in the ankylosing spondylitis group — 37.7%, in psoriatic arthritis — 62.5%, in the psoriatic spondyloarthritis group — 51.7%, conduction disturbance in ankylosing spondylitis — 28, 3%, in psoriatic arthritis — 17.5%, in the psoriatic spondyloarthritis group — 18.3%, dyslipidemia is significantly more common in the psoriatic arthritis and psoriatic spondyloarthritis groups — 47.5% and 51.7%, respectively, compared with the ankylosing spondylitis group — 18.9%. Along with cardiovascular diseases, endocrine disorders were detected with a high frequency of occurrence: overweight was more common in patients of the psoriatic arthritis and psoriatic spondyloarthritis groups — 35.0 and 38.3%, respectively, significant differences in the incidence of type 2 diabetes mellitus in the three groups has not been identified. CONCLUSIONS: It is necessary to carry out medical examination in order to identify comorbidities in patients with various forms of spondyloarthritis, in order to determine further tactics of management and correction, depending not only on the activity of the disease, but also taking into account comorbidities.
BACKGROUND: Group of spondyloarthritis include not only damage of musculoskeletal system, oftenly it’s combination with a variety of comorbid pathologies, primarily involving the cardiovascular system, is characteristic. Given the high importance of early detection, assessment and further prediction of the risks of cardiovascular diseases in this cohort of patients, a competent interpretation of the risks of aggravating cardiovascular diseases and their prevention is one of the priority tasks not only for rheumatologists, but also for specialists in related fields. AIM: To study the structure of comorbid pathology and assess the frequency of cardiovascular diseases in patients with ankylosing spondylitis, psoriatic arthritis and psoriatic spondyloarthritis, to conduct a comparative analysis of the incidence of cardiovascular comorbidities in different groups of spondyloarthritis. MATERIALS AND METHODS: The study included 153 patients with a verified diagnosis of spondyloarthritis. Patients were divided into 3 groups depending on the nature of the lesion of the musculoskeletal system: ankylosing spondylitis meeting the modified New York criteria for ankylosing spondylitis (1984) (n = 53), psoriatic arthritis meeting the CASPAR criteria (Classification criteria of Psoriatic Arthritis, 2006) (n = 40) and psoriatic spondylitis simultaneously meeting the modified New York criteria for ankylosing spondylitis and the CASPAR criteria for psoriatic arthritis (n = 60). All patients taken with monoclonal antibodies (inhibitors TNF-alpha). RESULTS: When studying cardiovascular comorbidity in patients with spondyloarthritis in three groups, arterial hypertension was most common in the ankylosing spondylitis group — 37.7%, in psoriatic arthritis — 62.5%, in the psoriatic spondyloarthritis group — 51.7%, conduction disturbance in ankylosing spondylitis — 28, 3%, in psoriatic arthritis — 17.5%, in the psoriatic spondyloarthritis group — 18.3%, dyslipidemia is significantly more common in the psoriatic arthritis and psoriatic spondyloarthritis groups — 47.5% and 51.7%, respectively, compared with the ankylosing spondylitis group — 18.9%. Along with cardiovascular diseases, endocrine disorders were detected with a high frequency of occurrence: overweight was more common in patients of the psoriatic arthritis and psoriatic spondyloarthritis groups — 35.0 and 38.3%, respectively, significant differences in the incidence of type 2 diabetes mellitus in the three groups has not been identified. CONCLUSIONS: It is necessary to carry out medical examination in order to identify comorbidities in patients with various forms of spondyloarthritis, in order to determine further tactics of management and correction, depending not only on the activity of the disease, but also taking into account comorbidities.
Objective: to evaluate the features of development and course of arterial hypertension (AH) and changes in vascular stiffness in patients with ankylosing spondylitis (AS) who underwent COVID-19. Materials and methods: 60 patients with a reliable diagnosis of AS were included in the study. Patients were divided into 2 groups depending on the presence of COVID - 19 in anamnesis. The main group consisted of 30 patients with AS who had suffered COVID-19 of varying severity during the previous 12 months. The comparison group consisted of 30 patients with AS who had no laboratory and clinically confirmed COVID-19 infection within the last year. Patients were interviewed regarding the severity of their previous coronavirus infection and persisting symptoms in the post-COVID-19 period. AS activity was evaluated by ASDAS (CRB, BASDAI-index). BP measurement and study of arterial stiffness parameters by oscillographic method, evaluation of the results of ambulatory BP measurement were performed. Results: 6 (20%) patients had BP destabilization at the outpatient stage during home BP measurement early after COVID-19. After 12 months, BP elevation persisted in only 2 (7%) patients, the rest had BP stabilization with withdrawal of antihypertensive drugs. No correlation between BP level, arterial stiffness and AS activity was found. There was a weak inverse correlation between the severity of coronavirus infection and the level of systolic blood pressure, between age and pulse wave velocity. No significant differences in systolic, diastolic blood pressure, pulse wave velocity, aortic augmentation index were found in patients with AS with and without coronavirus infection. In the main group, 1 fatal outcome due to the development of acute ST-elevation myocardial infarction 6 months after COVID-19 was recorded, and no adverse cardiovascular events were registered among patients in the comparison group. Conclusion: it was hypothesized that patients with AS who underwent COVID-19 would be more likely to show BP elevation than those who did not undergo COVID-19. It was found that early after COVID-19 (first three months) a reversible increase in BP without significant changes in arterial stiffness is possible. However, no significant differences in the frequency of BP elevation, BP level, and arterial stiffness were found in patients with AS and COVID-19 or without COVID-19 in anamnesis.
Аннотация Введение. Анкилозирующий спондилит (АС) связан с повышенным риском сердечно-сосудистых заболеваний (ССЗ). Известные рискометры могут недооценивать возможность наступления сердечно-сосудистых катастроф и не учитывают особенности течения воспалительных ревматических заболеваний. Для улучшения стратификации риска и своевременной профилактики необходимо изучение факторов, ассоциированных с поражением сердечно-сосудистой системы при АС. Цель исследования: изучение факторов риска, ассоциированных с атеросклеротическим поражением брахиоцефальных артерий (БЦА) при АС. Материал и методы. В исследование включены 32 больных АС (мужчины), которым выполнено общеклиническое обследование, выявлены традиционные факторы сердечно-сосудистого риска, определена активность и функциональный статус заболевания. Для диагностики атеросклеротического поражения БЦА использована ультразвуковая допплерография с измерением толщины комплекса «интима-медиа» (ТКИМ) и выявлением атеросклеротических бляшек. Результаты. ТКИМ в группе составила 0,9 мм [0,7; 1,2], медиана возраста-38,2 года [32,0; 43,5]. При применении половозрастных норм увеличение ТКИМ наблюдали у 80,6% пациентов. При проведении корреляционного анализа в структуре традиционных факторов риска значимые ассоциации ТКИМ продемонстрированы с возрастом ((r = 0,609; р < 0,0001), индексом массы тела (r = 0,439; р = 0,013), уровнем глюкозы ((r = 0,528; р = 0,002), триглицеридов ((r = 0,458; р = 0,010) и общего холестерина ((r = 0,398; р = 0,027). Преимущественно в группе с увеличенной ТКИМ встречалась высокая частота курения (6 из 16 против 14 из 16, χ 2 = 7,888; р = 0,009) и распространенности артериальной гипертензии (4 из 16 против 10 из 16, χ 2 = 7,630; р = 0,009). Статистически значимых различий и взаимосвязей ТКИМ с показателями активности заболевания не выявлено, также не была прослежена взаимосвязь с проводимой противоревматической терапией. Установлена значимая взаимосвязь между атеросклеротическим поражением БЦА больных АС с длительностью заболевания ((r = 0,370; р = 0,041) и функциональным статусом, оцениваемым при помощи индекса BASFI ((r = 0,507; р = 0,004). Заключение. Исследование выявило высокую распространенность традиционных факторов сердечно-сосудистого риска среди больных АС, а также тесную взаимосвязь длительности заболевания и степени функциональных нарушений с атеросклеротическим поражением БЦА. Полученные результаты показывают, что необходима более тщательная оценка риска развития ССЗ у больных АС, а также использование дополнительных объективных критериев. Ключевые слова: анкилозирующий спондилит, комплекс «интима-медиа», атеросклероз, факторы риска. Конфликт интересов: авторы заявляют об отсутствии конфликта интересов. Прозрачность финансовой деятельности: никто из авторов не имеет финансовой заинтересованности в представленных материалах и методах.
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