title: Increased arterial wall inflammation in patients with ankylosing spondylitis is reduced by statin therapy.
abstract: Ankylosing spondylitis (AS) is a chronic inflammatory disease with involvement of axial and sacroiliac joints. In addition, patients with AS have increased risk of cardiovascular disease (CVD), which might be attributed to enhanced inflammatory activity of the arterial wall. In the present study, we compared the level of carotid arterial wall inflammation in patients with AS with healthy controls using (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography with CT. As arterial wall inflammation is reduced by statin therapy, we subsequently assessed the effect of 3-month statin therapy on arterial wall inflammation in AS.
  
  
  
  We included 24 patients with AS (age 44±10, 72% males) without a history of CVD and 20 controls matched for age and gender. Patients with AS had lower high-density lipoprotein cholesterol and increased C reactive protein (CRP) compared with controls. The 10-year CVD risk was 2% in both groups. Notwithstanding, patients with AS had a 20% increase in arterial wall (18)F-FDG uptake compared with controls. Three-month atorvastatin 40 mg daily significantly lowered low-density lipoprotein cholesterol (baseline 3.55±1.15 mmol/L, -53%) and CRP (baseline 5.0 (1.5-9.3) mg/L, -58%) with a concomitant decrease of carotid arterial wall inflammation (maximum target-to-background ratio from 1.90±0.30 to 1.67±0.27; p=0.009).
  
  
  
  Patients with AS and without other CVD risk factors have increased arterial wall inflammation, which decreases upon statin therapy. These subjects are not identified as being at risk in current cardiovascular prevention guidelines. Our data support the need to revise CV disease management in AS, with perhaps a role for early statin therapy.
authors.affiliation: Department of Vascular Medicine, AMC, Amsterdam, The Netherlands.
authors.forename: Fleur M
authors.initials: FM
authors.lastname: van der Valk
authors.affiliation: Department of Vascular Medicine, AMC, Amsterdam, The Netherlands.
authors.forename: Sophie J
authors.identifier: 0000-0001-6915-521X
authors.initials: SJ
authors.lastname: Bernelot Moens
authors.affiliation: Department of Vascular Medicine, AMC, Amsterdam, The Netherlands.
authors.forename: Simone L
authors.initials: SL
authors.lastname: Verweij
authors.affiliation: Department of Vascular Medicine, AMC, Amsterdam, The Netherlands.
authors.forename: Aart C
authors.initials: AC
authors.lastname: Strang
authors.affiliation: Department of Radiology, AMC, Amsterdam, The Netherlands.
authors.forename: Aart J
authors.initials: AJ
authors.lastname: Nederveen
authors.affiliation: Department of Nuclear Medicine, AMC, Amsterdam, The Netherlands.
authors.forename: Hein J
authors.initials: HJ
authors.lastname: Verberne
authors.affiliation: Departments of Rheumatology Reade, Amsterdam Rheumatology immunology Center, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Nurmohamed
authors.affiliation: Department of Clinical Immunology and Rheumatology, AMC, Amsterdam, The Netherlands.
authors.forename: Dominique L
authors.initials: DL
authors.lastname: Baeten
authors.affiliation: Department of Vascular Medicine, AMC, Amsterdam, The Netherlands.
authors.forename: Erik S G
authors.initials: ES
authors.lastname: Stroes
mesh_terms: D000328:Adult; D000069059:Atorvastatin / Q000008:administration & dosage*; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000209:etiology; D002339:Carotid Arteries / Q000187:drug effects* / Q000473:pathology; D002340:Carotid Artery Diseases / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D016022:Case-Control Studies; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008075:Lipoproteins, HDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013167:Spondylitis, Ankylosing / Q000097:blood / Q000150:complications* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008075:Lipoproteins, HDL; D002097:C-Reactive Protein; D000069059:Atorvastatin
keywords: Ankylosing Spondylitis; Atherosclerosis; Cardiovascular Disease; Inflammation; Treatment