Assessment of serum asymmetric dimethylarginine levels and left ventricular diastolic function in patients with ankylosing spondylitis

• Published in: International journal of rheumatic diseases Vol. 20; no. 2; pp. 238 - 244
• Main Authors: Inci, Umit, Yildiz, Abdulkadir, Batmaz, Ibrahim, Tekbas, Ebru
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.02.2017
• Subjects: Adult; Ankylosing spondylitis; Antirheumatic Agents - therapeutic use; anti‐TNF‐α; Arginine - analogs & derivatives; Arginine - blood; asymmetric dimethylarginine; Biological Products - therapeutic use; Biomarkers - blood; Blood Sedimentation; C-reactive protein; C-Reactive Protein - metabolism; Cardiovascular diseases; Cardiovascular system; Case-Control Studies; Cross-Sectional Studies; Diastole; diastolic function; Disability Evaluation; Doppler effect; Echocardiography; Echocardiography, Doppler; Erythrocyte sedimentation rate; Female; Health risk assessment; Heart; Humans; Male; Nitric oxide; Nitric Oxide - metabolism; Risk factors; Spondylitis; Spondylitis, Ankylosing - blood; Spondylitis, Ankylosing - diagnosis; Spondylitis, Ankylosing - drug therapy; Spondylitis, Ankylosing - physiopathology; Statistical analysis; Treatment Outcome; Tumor necrosis factor; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor Necrosis Factor-alpha - immunology; Tumor necrosis factor-TNF; Ultrasonic imaging; Ventricle; Ventricular Function, Left - drug effects; Young Adult; diastolic function; anti-TNF-α; asymmetric dimethylarginine; ankylosing spondylitis
• ISSN: 1756-1841; 1756-185X
• DOI: 10.1111/1756-185X.12608

Aim To assess left ventricular diastolic functions and serum dimethylarginine (ADMA) concentrations, as well as the effect of different treatment strategies on ADMA concentrations and diastolic function parameters, in patients with ankylosing spondylitis (AS). Method Sixty AS patients and 40 control subjects without classical cardiovascular (CV) risk factors were included in the study. Baseline clinical and echocardiographic variables were obtained. C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR) and ADMA levels were measured. Spinal mobility, disease activity and functional status were assessed using Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index. Results CRP, ESR and ADMA levels were significantly higher in the AS group as compared to the control group. Two (5%) control subjects and six (10%) AS patients met the criteria for left ventricular diastolic dysfunction (DD) on conventional Doppler echocardiography, but the difference was not statistically significant (P = 0.36). However, using tissue Doppler imaging, 12 (20%) patients in the AS group and three (8%) subjects in the control group were diagnosed with left ventricular DD (P = 0.08). The anti‐tumor necrosis factor (TNF)‐α group, conventional therapy group and control group were compared in terms of ADMA, CRP, ESR levels and echocardiographic parameters. ADMA levels were significantly lower in anti‐TNF‐α group as compared to the conventional therapy group (P < 0.001). In the control group, ADMA levels were significantly lower than both treatment groups (P < 0.001). Conclusion Increased ADMA levels reveal impaired nitric oxide metabolism in a relatively young group of patients with AS, who have no classical CV risk factors. Anti‐TNF‐α may have beneficial effect on endothelial function in AS patients by reducing ADMA levels.