POS1407 COMPARISON OF CAROTID SUBCLINICAL ATHEROSCLEROSIS AND STRUCTURAL DAMAGE IN AXIAL SPONDYLITIS WITH AND WITHOUT CONCOMITANT INFLAMMATORY BOWEL DISEASE. A MULTICENTER STUDY WITH 886 PATIENTS. . A MULTICENTER STUDY WITH 886 PATIENTS
Authors: I. González-Mazón, J. Rueda-Gotor, I. Ferraz-Amaro, L. Sanchez-Bilbao, F. Genre, V. Calvo-Río, S. Remuzgo-Martínez, V. Pulito-Cueto, A. Corrales, L. Lera-Gómez, V. Portilla, V. Hernández-Hernández, J. C. Quevedo-Abeledo, C. Rodríguez-Lozano, C. López-Medina, M. L. Ladehesa Pineda, S. Castañeda, N. Garcia-Castañeda, C. Fernández-Carballido, M. P. Martínez-Vidal, D. Castro-Corredor, J. Anino-Fernández, D. Peiteado, C. Plasencia, M. L. García Vivar, E. Galindez, E. Montes Pérez, C. Fernández-Díaz, R. Blanco, M. A. González-Gay
Journal: Annals of the Rheumatic Diseases (2021)

Background: The prevalence of inflammatory bowel disease (IBD) in ankylosing spondylitis (AS) has been reported to range between 6%-15%. As occurs with axial spondyloarthrtitis (axSpA), patients with IBD have an increased risk of cardiovascular (CV) events because of a process of accelerated atherosclerosis 1 . However, it is unknown whether the presence of IBD confers an increased cardiovascular CV risk in patients with axSpA. Objectives: To compare the atherosclerotic burden, CV events, CV risk factors and disease related factors including structural damage in axSpA patients with and without IBD. Methods: Cross-sectional analysis of the AtheSpAin cohort, a Spanish multicenter cohort designed for the study of atherosclerosis in axSpA, comparing axSpA patients with and without concomitant IBD. Background information on CV and disease-related factors was reviewed. Data on CV risk and disease status at the time of the study were also obtained, including the structural damage assessed by the presence of syndesmophytes, the severity of the sacroiliitis (defined as grade 3 or 4 according to New York criteria), and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Carotid ultrasound (US) was performed in all patients at the time of the study, including measurement of carotid intima-media wall thickness (cIMT) and plaque detection according to the Mannhein consensus criteria. Results: A set of 886 axSpA patients were included. 829 (93.6%) of them had no concomitant IBD, which was present in 57 (6.4%) patients. Age, sex and AS/nr-axSpA ratio were comparable in both groups (Table 1. next page). Patients with IBD were characterised by a lower prevalence of HLA B27 (46% vs 72%, p=0.01) and a higher presence of concomitant psoriasis (21% vs 10%, p=0.01) Regarding peripheral disease (history of synovitis, enthesitis, dactylitis) and hip involvement, no differences were found between both groups. There were either no differences in the structural damage found in patients with and without IBD (Table 1. next page). With respect to the management of the disease, prednisone (21% vs 13%, p = 0.03), DMARDs (54% vs 35%, p = 0.01) and anti-TNFα therapy (54% vs 31%, p = 0.00) were more commonly used in the group with IBD, while treatment with NSAIDs was more frequent in patients without IBD (81% vs 70%, p = 0.04). Regarding CV risk features, smoking was more frequent in patients without IBD (34% vs 21%, p = 0.045) (Table 1. next page). No differences were observed neither in the lipid profile or blood pressure at the time of the study, nor in the prevalence of CV events (5% vs 4%, p=0.99) (Table 1) and the subclinical atherogenic burden assessed both by the presence of carotid plaques (31% vs 37%, p=0.45) and the cIMT (645 ± 147 mm vs 636 ± 112 mm, p = 0.64) (Table 1. next page). Conclusion: The presence of IBD does not confer additional CV risk to axSpA. In our series, patients with axSpA and IBD showed a lower frequency of HLA B27 and a higher prevalence of psoriasis. Table 1. axSpA without IBD (n=829 ) axSpA with IBD (n=57 ) p Men/Women, n 272/557 15/42 0.33 Mean age (years) ±SD at the time of study 49 ± 13 49 ± 10 0.99 AS/nr-AxSpa 656/173 45/12 0.97 History of CV risk factors Current smoker 285 (34) 12 (21) 0.045 Obesitty Dyslipemia 280 (34) 16 (28) 0.42 Hypertension 223 (27) 16 (28) 0.79 Diabetes Mellitus 60 (7) 4 (7) 0.99 Chronic Kidney Disease 20 (2) 2 (4) 0.65 History of cardiovascular events, n (% ) 40 (5) 2 (4) 0.99 Structural damage at the time of study Presence of syndesmophytes, n (%) 307 (37%) 23 (49%) 0.66 mSASSS 5 (1-15) 6 (3-23) 0.64 Severe sacroiliitis (grade 3,4), n (%) 436 (53) 34 (60) 0.42 CV data at the time of study Carotid plaques 261 (31) 21 (37) 0.45 IMT (mm) 645 ± 147 636 ± 112 0.64 IMT &gt;= 0.9 mm 46 (6) 0 (0) 0.066 Abbreviations: AS = ankylosing spondylitis. AxSpA= axial spondylitis. CV = cardiovascular. IBD = Inflammatory bowel disease. IMT = intima-media wall thickness. Nr-axSpA = no-radiographic axial spondylitis. Disclosure of Interests: None declared