Progression of subclinical atherosclerosis in systemic lupus erythematosus versus rheumatoid arthritis: the impact of low disease activity
Progression of subclinical atherosclerosis in systemic lupus erythematosus versus rheumatoid arthritis: the impact of low disease activity
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DOI：
10.1093/rheumatology/key233
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发表时间：
2018-12-01
期刊：
影响因子：
5.5
通讯作者：
Tektonidou, Maria G.
中科院分区：
文献类型：
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作者：
Kravvariti, Evrydiki;Konstantonis, George;Tektonidou, Maria G.
目标。系统性红斑狼疮和类风湿性关节炎的亚临床动脉粥样硬化的进展还没有得到比较评估。我们试图调查低疾病活动度和其他疾病相关因素对SLE与RA动脉粥样硬化进展的影响。我们对101名SLE患者、85名RA患者和85名对照组进行了为期3年的颈动脉和股动脉超声随访，并对115名SLE患者和1：1年龄与性别匹配的RA患者和对照组进行了基线检查。我们使用Logistic回归来比较SLE和RA与对照组之间的动脉粥样硬化进展(新斑块形成)，并评估具有不同狼疮低活动状态(LLDAS)持续时间的SLE患者的进展决定因素，调整疾病相关因素、抗高血压药物、抗血小板、他汀类药物和系统性冠状动脉风险评估10年心血管风险。斑块进展的优势比(OR)在系统性红斑狼疮组显著高于对照组(OR=2.81，P=0.043)，而在类风湿性关节炎(RA)组无显著差异(OR=2.22，P=0.109)。在疾病活动性较低的患者中，结果相似(SLE的88%，RA的74%)。影响系统性红斑狼疮进展的多因素包括抗磷脂抗体(OR=2.00，P=0.043)和全身性冠状动脉风险评估(OR=2.87，P=0.019)，以及LLDAS患者整个随访期间的累积皮质类固醇剂量(OR=1.38，P=0.013)和病程(OR=1.20，P=0.022)。对于LLDAS持续时间较短的患者(>；75%或>；50%的随访)，结果相似。斑块进展在SLE中加速，与疾病活动性无关，并与抗磷脂抗体和系统性冠状动脉风险评估有关。在LLDAS中，累积皮质类固醇剂量和病程是进展的额外决定因素。
Objectives. The progression of subclinical atherosclerosis in SLE and RA has not been comparatively assessed. We sought to investigate the impact of low disease activity and other disease-related factors on atherosclerosis progression in SLE vs RA.Methods. We performed a 3-year follow-up carotid and femoral artery ultrasound in 101 patients with SLE, 85 with RA and 85 controls after a baseline examination in 115 SLE and 1:1 age- and gender-matched RA patients and controls. We used logistic regression to compare atherosclerosis progression (new plaque development) between SLE and RA vs controls, and assess determinants of progression in SLE patients with different lupus low disease activity state (LLDAS) durations, adjusting for disease-related factors, antihypertensives, antiplatelets, statins and the Systemic Coronary Risk Evaluation 10-year cardiovascular risk.Results. The odds ratio (OR) of plaque progression vs controls was significantly higher in SLE (OR = 2.81, P = 0.043), but not in RA (OR = 2.22, P = 0.109). Results were similar in patients with low disease activity (88% of SLE, 74% of RA). Multivariate determinants of progression in SLE included antiphospholipid antibodies (OR = 2.00, P = 0.043) and Systemic Coronary Risk Evaluation (OR = 2.87, P = 0.019) for all patients, and additionally cumulative corticosteroid dose during follow-up (OR = 1.38, P = 0.013) and disease duration (OR = 1.20, P = 0.022) for patients in LLDAS over entire follow-up. Results were similar for patients with shorter LLDAS durations (>75% or >50% of follow-up).Conclusion. Plaque progression is accelerated in SLE regardless of disease activity, and is associated with antiphospholipid antibodies and the Systemic Coronary Risk Evaluation. In LLDAS, cumulative corticosteroid dose and disease duration are additional determinants of progression.