title: Subclinical atherosclerosis and impaired bone health in patients with primary Sjogren's syndrome: prevalence, clinical and laboratory associations.
abstract: BACKGROUND
  To determine the prevalence and clinical/laboratory associations of subclinical atherosclerosis and impaired bone health in primary Sjogren's syndrome (SS).
  
  
  METHODS
  64 consecutive patients with primary SS, 77 with rheumatoid arthritis (RA) and 60 healthy controls (HC) οf similar age and sex distribution were enrolled. Demographics, clinical/laboratory features, classical risk factors for atherosclerosis and osteoporosis (OP) were recorded. Intima-medial thickness scores (IMT) and carotid/femoral (C/F) plaque formation, as well as bone mineral density (BMD) and fractures were evaluated. Determinants of IMT/BMD levels and the presence of plaque were assessed by univariate and multivariate models. Serum levels of the Wnt signaling mediators Dickkopf-related protein 1(DKK1) and sclerostin were determined in primary SS patients and HC.
  
  
  RESULTS
  Increased arterial wall thickening (IMT > 0.90 mm) and impaired bone health (defined as OP or osteopenia), were detected in approximately two-thirds of primary SS and RA patients, with a mean IMT value being significantly increased compared to HC. The presence of primary SS emerged as an independent risk factor for arterial wall thickening when traditional risk factors for cardiovascular disease (CVD) including age, sex, hypertension, smoking (pack/years), LDL and HDL levels were taken into account in a multivariate model [adjusted OR 95% (CI): 2.8 (1.04-7.54)]. In primary SS, age was revealed as independent predictor of increased IMT scores; age and lymphopenia as well as increased urine pH as independent determinants of C/F plaque formation and OP/osteopenia, respectively. An independent association of OP/osteopenia with plaque formation was observed when independent predictors for both variables were considered, with low DKK1 levels being associated with both plaque formation and lower BMD levels.
  
  
  CONCLUSIONS
  Comorbidities such as subclinical atherosclerosis and impaired bone health occur frequently in primary SS, in association with disease related features and traditional risk factors. Wnt signaling mediators are potentially involved in the pathogenesis of both entities.
authors.affiliation: Department of Rheumatology, General Hospital of Athens "G.Gennimatas", Athens, Greece. fotinigravani@yahoo.gr.|Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece. fotinigravani@yahoo.gr.
authors.forename: Fotini
authors.initials: F
authors.lastname: Gravani
authors.affiliation: Department of Rheumatology, General Hospital of Athens "G.Gennimatas", Athens, Greece. iopapadaki@yahoo.com.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Papadaki
authors.affiliation: Department of Radiology, General Hospital of Athens "G.Gennimatas", Athens, Greece. kostalymp@gmail.com.
authors.forename: Eleni
authors.initials: E
authors.lastname: Antypa
authors.affiliation: Department of Physiology, School of Medicine, University of Athens, M. Asias 75, Athens, 11527, Greece. anezos@med.uoa.gr.
authors.forename: Andrianos
authors.initials: A
authors.lastname: Nezos
authors.affiliation: Department of Immunology, General Hospital of Athens "G. Gennimatas", Athens, Greece. kikimasselou@yahoo.gr.
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Masselou
authors.affiliation: Department of Rheumatology, General Hospital of Athens "G.Gennimatas", Athens, Greece. dioakim@otenet.gr.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Ioakeimidis
authors.affiliation: Department of Physiology, School of Medicine, University of Athens, M. Asias 75, Athens, 11527, Greece. mkoutsil@med.uoa.gr.
authors.forename: Michael
authors.initials: M
authors.lastname: Koutsilieris
authors.affiliation: Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece. hmoutsop@med.uoa.grv.
authors.forename: Haralampos M
authors.initials: HM
authors.lastname: Moutsopoulos
authors.affiliation: Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece. kmauragan@med.uoa.gr.|Department of Physiology, School of Medicine, University of Athens, M. Asias 75, Athens, 11527, Greece. kmauragan@med.uoa.gr.
authors.forename: Clio P
authors.initials: CP
authors.lastname: Mavragani
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000453:epidemiology* / Q000473:pathology*; D050197:Atherosclerosis / Q000453:epidemiology* / Q000473:pathology*; D015519:Bone Density / Q000502:physiology; D001851:Bone Diseases, Metabolic / Q000453:epidemiology / Q000473:pathology; D002318:Cardiovascular Diseases; D002340:Carotid Artery Diseases / Q000453:epidemiology / Q000473:pathology; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D012859:Sjogren's Syndrome / Q000453:epidemiology* / Q000473:pathology*; D018709:Statistics, Nonparametric; D017539:Tunica Intima / Q000473:pathology