Patterns of dyslipidemia in young patients with seronegative spondyloarthropathies without cardiovascular diseases.

OBJECTIVES: Patients with seronegative spondyloarthritis (SpA) - psoriatic arthritis (PsA) and ankylosing spondylitis (AS) - have a higher risk of cardiovascular morbidity and mortality. The aim of the present study was to evaluate the incidence and type of dyslipidemia, a potent atherosclerosis risk factor, in SpA patients. MATERIAL AND METHODS: It was a two-center, case-control study. Patients diagnosed with PsA and AS aged 23-60 years, with disease duration < 10 years, were enrolled. The inflammatory activity, serum levels of C-reactive protein (CRP) and lipid profile were evaluated in each patient. In patients > 40 years old, the 10-year risk of fatal cardiovascular disease (CVD), using Systematic Coronary Risk Evaluation (SCORE), was estimated. RESULTS: In total 79 patients with SpA were included in the study, with PsA diagnosed, n = 39 (mean age 45.1 ±9.6 years; 21, 53.9%, women), and with AS diagnosed, n = 40 (age 40.3 ±9.5; 12.3%, women), control group (CG): n = 88 (age 42.3 ±8.1; 42, 47.7% women). Based on the interview and laboratory tests, dyslipidemia was diagnosed in 19 (47.5%) patients with AS and in 28 (71.8%) patients with PsA. Most patients had hypercholesterolemia or mixed hyperlipidemia. Types of dyslipidemia were similar. In SpA patients (PsA and AS), the level of triglycerides (TG) and atherogenic index (AI) were significantly higher than in the CG, respectively TG in SpA: 116 (83-156) and in the CG: 91.2 (72.6-134.6) mg/dl, p = 0.0182; AI in SpA: 3.77 ±1.26 and in the CG: 2.58 ±1.27, p < 0.0001.The low-density cholesterol (LDL) level was significantly lower in SpA patients than in the CG, SpA: 109.1 ±29.4 vs. CG: 125.2 ±35.9 mg/dl, p = 0.0023. There was a strong negative correlation between CRP levels and HDL cholesterol levels in patients with PsA, rho = 0.42, p = 0.0132. Mean SCORE values were 2.33% in PsA patients and 2.38% in AS patients, which results in moderate 10-year risk of death from CVD. CONCLUSIONS: In young patients with spondyloarthropathies, inflammatory factors significantly influence dyslipidemia patterns, which result in higher TG and lower LDL cholesterol levels. In patients with PsA, dyslipidemia was diagnosed more often than in patients with AS.

Increased prevalence of subclinical coronary atherosclerosis in young patients with ankylosing spondylitis.

Introduction There is substantial evidence that spondyloarthropathies, such as ankylosing spondylitis (AS) and psoriatic arthritis (PsA), may increase cardiovascular risk. Objectives The study aimed to compare development of atherosclerotic lesions in coronary arteries between patients with AS and individuals without rheumatic dise ases. Patients and methods A total of 37 adult patients with AS (mean [SD] age, 40.4 [9.6] years; men, 26 [70.3%]), with disease duration of less than 10 years were enrolled. The control group consisted of 76 participants without rheumatic diseases. Controls were matched for age, sex, history of hypertension, dyslipidemia, and smoking status. Coronary computed tomography angiography was performed in both groups. Results Atherosclerotic lesions in the coronary arteries were present in 18 patients (48.7%) with AS compared with 20 controls (26.3%) (P = 0.02). Univariate analysis performed in the AS group demonstrated an association between the presence of lesions and age (P = 0.02), hypertension (P = 0.003), and dyslipidemia (P = 0.001). The multivariable logistic regression analysis showed a significant association between coronary atherosclerosis and hypertension (P = 0.008) and with dyslipidemia (P = 0.001). The average plaque burden was higher in patients with AS than in controls (mean [SD], 42.2% [4.7%] vs 36.5% [3.1%], P <0.0001). Conclusions Atherosclerotic plaques in the coronary arteries were significantly more prevalent in patients with AS. A strong association was demonstrated between atherosclerotic lesions and age, hypertension, and dyslipidemia. Our results confirm the need for cardiovascular risk assessment in patients with AS and cardiovascular prevention, if indicated.

Sjögren's syndrome: still not fully understood disease.

Primary Sjögren's syndrome is an autoimmune disorder with external exocrine glands dysfunction and multiorgan involvement. The pathogenesis of primary Sjogren's syndrome is still unclear; however, our knowledge of the involvement of different cells (e.g., B and T cells, macrophages and dendritic cells) and pathways (BAFF/APRIL and interferons) leading to the development of autoimmunity is continually expanding. For clinicians, the most frequent symptoms are dryness of eyes and mouth, but often the patients have musculoskeletal symptoms and systemic manifestations. However, the increased risk of lymphoproliferative disorders in this group of patients, most commonly B-cell marginal zone lymphoma, is particularly important. Recent separation of IgG4-related diseases and attempts to create further diagnostic criteria for pSS testify to the difficulties, and at the same time a large interest, in understanding the disease so as to allow the effective treatment. This article draws attention to the problems faced by the clinician wishing to securely identify pSS by using accurate laboratory biomarkers and useful imaging tools and predict the development of complications associated with this, still not fully understood, autoimmune disease.