Knowledge gap
“There was a knowledge gap when it came to our understanding of the relationship between AS in connection to cardiovascular and cerebrovascular mortality,” explains Dr. Haroon. “Unlike rheumatoid arthritis, where manifestations are clearly present through joint pain in the feet, hands, and knees, for example, with AS, most of the inflammation exists within the bone and spine— places we cannot see. We know that cardiovascular mortality is higher in chronic inflammatory disease; resultantly, there has been increasing interest in studying this in relation to AS.”
Specifically, because the disease process of AS starts at a relatively younger age (15-45 years) in comparison to other forms of arthritis, this further underscores the importance of understanding all of the additional health risks.
“Patients with AS will have the disease for the next twenty to thirty years,” explains Dr. Haroon. “Even though it is very uncommon for patients at this age to have a heart attack or a stroke, this is a long time for inflammation to have an effect on blood vessels. As patients age, the risk of stroke and heart attack increases and the effects of AS can accelerate the onset of these conditions.”
“We should be very vigilant about other traditional risk factors — smoking, high cholesterol, diabetes, and lack of exercise,” notes Dr. Haroon. “These need to be closely monitored and addressed in patients with AS so that their risk of heart disease and stroke is decreased.”
Traditionally, patients with AS have been prescribed non-steroidal anti-inflammatory drugs to treat their symptoms. New treatments known as biologics, a type of medication meant to block certain proteins which underlie the inflammation in AS, have been shown to reduce symptoms and halt the progression of the disease. Dr. Haroon believes biologics may also have a role to play in reducing the onset of cardiovascular disease in patients with AS.
“If we believe that biologics control inflammation, and inflammation is responsible for cardiovascular disease, biologics should have a positive effect on reducing the incidence of an event,” he says. “We don’t have large population-based data to study this yet, but hopefully we will soon.”
WE KNOW THAT CARDIOVASCULAR MORTALITY I S HIGHER IN CHRONIC INFLAMMATORY DISEASE"
Other possible studies include examining early markers of cardiovascular disease to screen and treat modifiable risk factors in patients with AS.
“For example, you could conduct ultrasound studies to see if atherosclerotic blocks are developing in the major blood vessels,” explains Dr. Haroon. “We are also considering studying the effect of TNF inhibitor treatment (a type of biologic therapy), on decreasing the risk of mortality. Overall, our study suggests that large multicentre trials assessing whether TNF inhibitors are preventing or delaying the onset of vascular disease are warranted. ”
To support the work of Dr. Haroon and his colleagues in the Rheumatology Program, please contact Anette Larsson at anette.larsson@uhn.ca or 416 603 5800 x4059.
ARTHRITIS PROGRAM RHEUMATOLOGIST NAMED “MENTOR OF THE YEAR”
Dr. Dafna Gladman has received a special honour from the Royal College of Physicians and Surgeons of Canada. Named the 2015 Mentor of Year, Dr. Gladman has been recognized for her leadership in the treatment of psoriatic arthritis and lupus. The award was established to recognize Fellows of the Royal College in good standing who have had a significant impact on the career development of students, residents and/or Fellows.
Dr. Gladman is Deputy Director of the Centre for Prognosis Studies in the Rheumatic Diseases at Toronto Western Hospital, Director of the Psoriatic Arthritis Program, University Health Network, and co-director of the University of Toronto Lupus Clinic. She is also a professor of medicine at the University of Toronto, and senior scientist at the Toronto Western Research Institute. She has researched both systemic lupus erythematosus and psoriatic arthritis with emphasis on database development, prognosis studies, genetic markers for disease susceptibility and expression, assessment instruments and quality-of-life measures. She has also been involved in clinical trials in these conditions.
“We are tremendously proud of Dr. Gladman to be recognized by her peers in this way,” said Arthritis Program Medical Director Dr. Nizar Mahomed.
