Different clinical expression of patients with ankylosing spondylitis according to gender in relation to time since onset of disease. Data from REGISPONSER.

OBJECTIVE: To describe the differential characteristics by gender and time since disease onset in patients diagnosed with ankylosing spondylitis (AS) attending the Spanish rheumatology clinics, including those on the "Spanish Registry of spondyloarthritis" (REGISPONSER), as well as the diagnostic and therapeutic implications that this entails. PATIENTS AND METHODS: This is a transversal and observational study of 1514 patients with AS selected from 2367 spondyloarthritis cases included in REGISPONSER. For each patient, the demographics, epidemiology, geriatric, clinical, laboratory, radiological, and therapeutic aspects were were evaluated and comprehensively recorded under the aegis of REGISPONSER, constituting the Minimum Basic identifying data for the disease. Physical function was assessed by Bath Ankylosing Spondylitis Functional Index (BASFI). Clinical activity was evaluated using erythrocyte sedimentation rate, C reactive protein and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Each patient underwent pelvic anteroposterior, anteroposterior and lateral lumbar spine as well as lateral cervical spine x rays; they were scored according to the Bath Ankylosing Spondylitis Spine Radiographic Index, which measures structural damage. RESULTS: Of the 1514 patients screened, 1131 (74.7%) were men. We found significant differences in age at onset of symptoms as well as in the day of inclusion, between the two groups, being lower in men. We also obtained differences in the duration of the disease, which was lower in women. As for the existence of a history of AS among first-degree relatives, family forms were more common among women. The mean BASDAI score was also higher in women, regardless of time since onset of disease. In contrast, the improvement of pain with the use of NSAID's and radiological severity were higher in men, both reaching statistical significance. CONCLUSIONS: Among the Spanish AS patients, there are some differences in the clinical manifestations, even when the time since onset of disease was controlled; we also found radiological differences by gender; men showing more structural damage, while women were more active. These data suggest that the phenotype of AS differs between genders. This can influence the subsequent diagnostic approach and therapeutic decisions.

[Determinants of carotid subclinical atherosclerosis in patients with rheumatoid arthritis. A case-control study]. / Determinantes de la arteriosclerosis subclínica carotídea en pacientes con artritis reumatoide. Estudio de casos y controles.

BACKGROUND AND OBJECTIVE: Rheumatoid arthritis (RA) is characterized by high cardiovascular (CV) mortality, which seems related to systemic inflammation. Our aim was to quantify carotid atherosclerosis in RA and its relationship with the disease. PATIENTS AND METHOD: 73 RA patients and the same number of sex and age matched controls were enrolled, without history of cardiovascular events. Carotid intima-media thickness (IMT) and plaques were measured by ultrasonography. Its relationship with risk factors (RF), rheumatic disease characteristics, and inflammatory markers were analysed. RESULTS: Controls showed higher body mass index (BMI) and dyslipidemia. There were no differences in other risk factors or IMT. Age (p = 0.001), sex (p = 0.02), BMI (p = 0.002), waist perimeter (p = 0.001), and hypertension (p = 0.005) had a relationship with IMT. Among disease characteristics, only time elapsed since RA diagnosis was associated with IMT. CONCLUSIONS: There was not an increased carotid subclinical atherosclerosis in patients with RA, beyond the effects of classical RF.

Significado de la resistencia a la insulina en la enfermedad vascular asociada a la artritis reumatoide / Significance of the insulin resistance in vascular disease associated to rheumatoid arthritis

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Determinantes de la arteriosclerosis subclínica carotídea en pacientes con artritis reumatoide. Estudio de casos y controles / Determinants of carotid subclinical atherosclerosis in patients with rheumatoid arthritis. A case-control study

Fundamento y objetivo: En la artritis reumatoide (AR) hay un aumento de la morbimortalidad cardiovascular. Nuestro objetivo fue cuantificar la arteriosclerosis subclínica carotídea en pacientes con AR y su relación con la enfermedad. Pacientes y método: En 73 pacientes con AR y 73 controles, emparejados por edad y sexo, sin enfermedad vascular, se midió el grosor íntima-media (GIM) carotídeo y la presencia de placas mediante ecografía. Se analizó su relación con los factores de riesgo vascular (FRV), las características de la enfermedad y los parámetros inflamatorios. Resultados: Los controles presentaban mayor índice de masa corporal (IMC) y dislipemia, sin diferencias significativas entre ambos grupos en el resto de los FRV o en los valores del GIM. La edad (p = 0,001), el sexo (p = 0,02), el IMC (p = 0,002), el perímetro abdominal (p = 0,001) y la hipertensión arterial (p = 0,005) se relacionaron con el GIM. El tiempo desde el diagnóstico fue la única característica de la AR que se relacionó con el GIM. Conclusiones: No se ha encontrado un incremento de ateromatosis carotídea en pacientes con AR más allá del efecto atribuible a los FRV clásicos

Background and objective: Rheumatoid arthritis (RA) is characterized by high cardiovascular (CV) mortality, which seems related to systemic inflammation. Our aim was to quantify carotid atherosclerosis in RA and its relationship with the disease. Patients and method: 73 RA patients and the same number of sex and age matched controls were enrolled, without history of cardiovascular events. Carotid intima-media thickness (IMT) and plaques were measured by ultrasonography. Its relationship with risk factors (RF), rheumatic disease characteristics, and inflammatory markers were analysed. Results: Controls showed higher body mass index (BMI) and dyslipidemia. There were no differences in other risk factors or IMT. Age (p = 0.001), sex (p = 0.02), BMI (p = 0.002), waist perimeter (p = 0.001), and hypertension (p = 0.005) had a relationship with IMT. Among disease characteristics, only time elapsed since RA diagnosis was associated with IMT. Conclusions: There was not an increased carotid subclinical atherosclerosis in patients with RA, beyond the effects of classical RF