CORRELATION OF RADIOGRAPHIC DAMAGE AND METABOLIC SYNDROME IN SPONDYLOARTHRITIS: A CROSS-SECTIONAL STUDY
Background: Cardiovascular complication remains the long-term complications in spondyloarthritis (SpA). Previous studies revealed that metabolic
syndrome is the risk factor of cardiovascular in SpA patients. Previous studies also revealed that the prevalence of the metabolic syndrome is 34.9–
45.7% in SpA patients. However, previous studies also revealed the controversy of the correlation of SpA’ disease activity with metabolic syndrome.
Aim: The aim of the study was to investigate the correlation of SpA’ radiographical damage measured with a modified Stoke Ankylosing Spondylitis
Spinal Score (mSASSS) score with metabolic syndrome in SpA patients, which routinely visited Rheumatology Outpatient Department in Dr. Soetomo
Methods: An observational study with cross-sectional design with consecutive sampling technique was conducted in July–October 2018. All SpA
patients who fulfilled the inclusion criteria were included in this study. Data analysis was performed with SPSS v21.0.
Results: There were 33 SpA patients (10 males and 23 females) included in this study. The average age was 48.18±12.27 years-old. The average
mSASSS score was 24,36 (K:0.93, p:0.00). Metabolic syndrome was diagnosed in 54.5% patients with 100% patients had central obesity, 66.7% had
increased blood pressure, 61.5% had impaired fasting glucose, 55.6% had increased triglycerides, and 77.8% had decreased high-density lipoprotein
cholesterol. Positive correlation between mSASSS score and metabolic syndrome was observed (r:0.510, p:0.002).
Conclusion: A correlation between SpA disease activity measured with mSASSS score and metabolic syndrome was observed. Therefore, routine
metabolic syndrome screening is strongly suggested for SpA patients.
Chou CT, et al. The assessment of spondyloarthritis international
society classification criteria for peripheral spondyloarthritis and for
spondyloarthritis in general. Ann Rheum Dis 2011;70:25-31.
2. Zochling J, Brandt J, Braun J. The current concept of spondyloarthritis
with special emphasis on undifferentiated spondyloarthritis.
Rheumatology (Oxford) 2005;44:1483-91.
3. Mathieu S, Gossec L, Dougados M, Soubrier M. Cardiovascular profile
in ankylosing spondylitis: A systematic review and meta-analysis.
Arthritis Care Res (Hoboken) 2011;63:557-63.
4. Mathieu S, Pereira B, Soubrier M. Cardiovascular events in ankylosing
spondylitis: An updated meta-analysis. Semin Arthritis Rheum
5. Reaven G. The metabolic syndrome: Is this diagnosis necessary? Am J
Clin Nutr 2006;83:1237-47.
6. Malesci D, Niglio A, Mennillo GA, Buono R, Valentini G,
La Montagna G, et al. High prevalence of metabolic syndrome in
patients with ankylosing spondylitis. Clin Rheumatol 2007;26:710-4.
7. Papadakis JA, Sidiropoulos PI, Karvounaris SA, Vrentzos GE,
Spanakis EK, Ganotakis ES, et al. High prevalence of metabolic
syndrome and cardiovascular risk factors in men with ankylosing
spondylitis on anti-TNFalpha treatment: Correlation with disease
activity. Clin Exp Rheumatol 2009;27:292-8.
8. Monteiro R, Azevedo I. Chronic inflammation in obesity and the
metabolic syndrome. Mediators Inflamm 2010;2010:???.
9. Jung UJ, Choi MS. Obesity and its metabolic complications: The role of
adipokines and the relationship between obesity, inflammation, insulin
resistance, dyslipidemia and nonalcoholic fatty liver disease. Int J Mol
10. Blanco-Morales EA, Bravo-Ferrer J, Rey R, Bejerano C,
Fernandez C, Oreiro N, et al. FRI0208 metabolic syndrome in
spondyloarthritis. Prevalence and associated factors. Ann Rheumatic
11. Maia DG, Augusto KL, Bezerra MC, Rodrigues CEM. Metabolic
syndrome in patients with ankylosing spondylitis receiving anti-TNF?
therapy: Association with predictors of cardiovascular risk. Clin
12. Betancur G, Orozco MC, Schneeberger E, Lizarraga A, Zamora N,
Sommerfleck FA, et al. Prevalence of obesity and metabolic syndrome
in patients with axial spondyloarthritis. Arthritis Rheumatol 2015;67
13. Altan L, Sivrioglu Y, Ercan I. Can bath ankylosing spondylitis disease
activity index be affected by accompanying fibromyalgia or depression?
Arch Rheumatol 2015;30:34-9.
14. Pedersen SJ, Sørensen IJ, Garnero P, Johansen JS, Madsen OR,
Tvede N, et al. ASDAS, BASDAI and different treatment responses
and their relation to biomarkers of inflammation, cartilage and bone
turnover in patients with axial spondyloarthritis treated with TNF?
inhibitors. Ann Rheum Dis 2011;70:1375-81.
15. Creemers MC, Franssen MJ, van’t Hof MA, Gribnau FW, van de
Putte LB, van Riel PL, et al. Assessment of outcome in ankylosing
spondylitis: An extended radiographic scoring system. Ann Rheum Dis
16. Ibrahim A, Gladman DD, Thavaneswaran A, Eder L, Helliwell P,
Cook RJ, et al. Sensitivity and specificity of radiographic scoring
instruments for detecting change in axial psoriatic arthritis. Arthritis
Care Res (Hoboken) 2017;69:1700-5.
17. National cholesterol education program. Detection, evaluation, and
treatment of high blood cholesterol in adults (adult treatment panel III).
18. Tan CE, Ma S, Wai D, Chew SK, Tai ES. Can we apply the national
cholesterol education program adult treatment panel definition of the
metabolic syndrome to asians? Diabetes Care 2004;27:1182-6.
19. Tjokroprawiro A, Wibisono S. Guloh-sisar: Sepuluh Petunjuk Pola
Hidup Sehat. Seminar Untuk Dokter Anak Cabang Jawa Timur. Vol. 29.
Surabaya: Practical Guidelines fro Healthy Daily Life; 2014.
20. Harper BE, Reveille JD. Spondyloarthritis: Clinical suspicion,
diagnosis, and sports. Curr Sports Med Rep 2009;8:29-34.
21. Haroon NN, Paterson JM, Li P, Haroon N. Increasing proportion of
female patients with ankylosing spondylitis: A population-based
study of trends in the incidence and prevalence of AS. BMJ Open
22. Neuenschwander R, Ciurea A. Gender differences in axial
spondyloarthritis. World J Rheumatol 2014;4:35-43.
23. Soewondo P, Purnamasari D, Oemardi M, Waspadji S, Soegondo S.
Prevalence of metabolic syndrome using NCEP/ATP III criteria in
jakarta, indonesia: The jakarta primary non-communicable disease risk
factors surveillance 2006. Acta Med Indones 2010;42:199-203.
24. Papagoras C, Markatseli TE, Saougou I, Alamanos Y, Zikou AK,
Voulgari PV, et al. Cardiovascular risk profile in patients with
spondyloarthritis. Joint Bone Spine 2014;81:57-63.
25. Owczarczyk-Saczonek A, Drozdowski M, Maciejewska-Radomska A,
Choszcz D, Placek W. The effect of subcutaneous methotrexate on
markers of metabolic syndrome in psoriatic patients preliminary report.
Postepy Dermatol Alergol 2018;35:53-9.
26. Kozakowski J, Gietka-Czernel M, Leszczy?ska D, Majos A. Obesity
in menopause our negligence or an unfortunate inevitability? Prz
27. Ramiro S, van Tubergen A, Stolwijk C, Landewé R, van de Bosch F,
Dougados M, et al. Scoring radiographic progression in ankylosing
spondylitis: Should we use the modified stoke ankylosing spondylitis
spine score (mSASSS) or the radiographic ankylosing spondylitis
spinal score (RASSS)? Arthritis Res Ther 2013;15:R14.
28. Braun J, Pincus T. Mortality, course of disease and prognosis of patients
with ankylosing spondylitis. Clin Exp Rheumatol 2002;20:S16-22.
29. Raychaudhuri SP, Raychaudhuri SK. IL-23/IL-17 axis in
spondyloarthritis-bench to bedside. Clin Rheumatol 2016;35:1437-41.
30. Golden JB, McCormick TS, Ward NL. IL-17 in psoriasis:
Implications for therapy and cardiovascular co-morbidities. Cytokine
31. Aliling J, Brent lH. Criteria and disease activity measures in axial
spondyloarthropathies. Clin Adv Spondylitis 2016;2:2-38.
32. Braun J, Kiltz U, Baraliakos X, van der Heijde D. Optimisation of
rheumatology assessments the actual situation in axial spondyloarthritis
including ankylosing spondylitis. Clin Exp Rheumatol 2014;32:S-
This work is licensed under a Creative Commons Attribution 4.0 International License.