Adem KÜÇÜK, Semi ÖZTÜRK, Cevat KIRMA, Ahmet Seyfeddin GÜRBÜZ, Ali Uğur USLU, Süleyman ÇAĞAN EFE, Elbis AHBAB

Effect of amyloidosis and proteinuria on augmentation index in patients with familial mediterranean fever

Aim: Familial Mediterranean Fever (FMF) is an auto-inflammatory disease which is characterized by amyloid deposition in multipleorgans.Pulse wave velocity (PWV) and augmentation index (AIx) are associated with cardiovascular diseases and important predictorsof long term prognosis.We aimed to investigate effect of amyloidosis and amount of proteinuria on subclinical atherosclerosisdetermined by PWV and AIx in patients with FMF.Material and Methods: Aortic pulse wave velocity (PWV), augmentation index (AIx) were measured in 35 FMF patients (12 amyloidosisand 23 non-amyloidosis) and in 34 control subjects.Demographic, clinical and laboratory features and aortic stiffness parameterswere compared between three groups (control, FMF with and without amyloidosis).Results: There was no difference between groups in terms of age, gender, and cardiovascular risk factors. AIx was higher in FMFpatients with amyloidosis compared with FMF patients without amyloidosis and control group (respectively; p = 0.04, p = 0.006).AIx did not differ between FMF patients without amyloidosis and control group (p = 0.4).There was a positive correlation betweenAIx and amount of proteinuria in patients with FMF (r=0.51,p=0.002).Multivariable linear regression analysisdemonstrated that age,presence of amyloidosis and amount of proteinuria were independent factors affecting AIx.Conclusion: AIx is increased in FMF related amyloidosis.Presence of amyloidosis and amount of proteinuria in patients of FMF maybe associated with increased cardiovascular risk.

PDF

___

1. Sahin S, Yalcin I, Senel S, et al. Assesment life quality of familial Mediterranean fever patients by short form36 and its relationship with disease parameters. Eur Rev Med Pharmacol Sci 2013;17:958-63.
2. Yildirim K, Karatay S, Cetinkaya R, et al. Bone mineral density in patients with familial Mediterranean fever. Rheumatol Int 2010;30:305-8.
3. Lidar M, Livneh A. Familial mediterranean fever: Clinical, molecular and management advancements. Neth J Med 2007;65:318-24.
4. Akdogan A, Calguneri M, Yavuz B, et al. Are familial Mediterranean fever (FMF) patients at increased risk for atherosclerosis? Impaired endothelial function and increased intima media thickness are found in FMF. J Am Coll Cardiol 2006;48:2351-3.
5. Basar N, Kisacik B, Ercan S, et al. Familial Mediterranean fever gene mutations as a risk factor for early coronary artery disease. Int J Rheum Dis 2017;20:2113-7.
6. Mitchell GF, Lacourcière Y, Arnold JM, et al. Changes in aortic stiffness and augmentation index after acute converting enzyme or vasopeptidase inhibition. Hypertension 2005;46:1111-7.
7. Betge S, Kretzschmar D, Figulla HR, et al. Predictive value of the augmentation index derived vascular age in patients with newly diagnosed atherosclerosis. Heart Vessels 2017;32:252-9.
8. Pieringer H, Brummaier T, Schmid M,et al. Rheumatoid arthritis is an independent risk factor for an increased augmentation index regardless of the coexistence of traditional cardiovascular risk factors. Semin Arthritis Rheum 2012;42:17-22.
9. Barnes JN, Nualnim N, Sugawara J, et al. Arterial stiffening, wave reflection, and inflammation in habitually exercising systemic lupus erythematosus patients. Am J Hypertens 2011;24:1194-200.
10. Avram C, Drăgoi RG, Popoviciu H, et al. Association between arterial stiffness, disease activity and functional impairment in ankylosing spondylitis patients: a cross-sectional study. Clin Rheumatol 2016;35:2017-22.
11. Yilmaz MI, Demirkaya E, Acikel C, et al. Endothelial function in patients with familial Mediterranean fever-related amyloidosis and association with cardiovascular events. Rheumatology (Oxford) 2014;53:2002-8.
12. Gerstein HC, Mann JF, Yi Q, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001;286:421-6.
13. Pras M. Familial Mediterranean fever: from the clinical syndrome to the cloning of the pyrin gene. Scand J Rheumatol 1998;27:92-7.
14. Ozalper V, Kara M, Tanoglu A, et al. Evaluation of endothelial dysfunction in patients with familial Mediterranean fever: the relationship between the levels of asymmetric dimethylarginine and endocan with carotid intima-media thickness and endothelium-dependent vasodilation. Clin Rheumatol 2017;36:2071-7.
15. Peru H, Altun B, Doğan M, et al. The evaluation of carotid intima-media thickness in children with familial Mediterranean fever. Clin Rheumatol 2008;27:689-94.
16. Ugurlu S, Seyahi E, Cetinkaya F, et al. Intima-media thickening in patients with familial Mediterranean fever. Rheumatology (Oxford) 2009;48:911-5.
17. Caliskan M, Gullu H, Yilmaz S, et al. Impaired coronary microvascular function in familial Mediterranean fever. Atherosclerosis 2007;195:161-7.
18. Yildiz M, Masatlioglu S, Seymen P, et al. The carotidfemoral (aortic) pulse wave velocity as a marker of arterial stiffness in familial Mediterranean fever. Can J Cardiol 2006;22:1127-31.
19. Yılmaz F, Ulu S, Akcı Ö, et al. Evaluation of arterial stiffness with plasma GGT levels and pulse wave velocity measurement in patients with FMF. Eur J Rheumatol 2014;1:11-3.
20. Kukuy O, Livneh A, Mendel L, et al. Normal arterial stiffness in familial Mediterranean fever. Evidence for a possible cardiovascular protective role of colchicine. Clin Exp Rheumatol 2017;108:32-7.
21. Sasatomi Y, Sato H, Chiba Y, et al. Prognostic factors for renal amyloidosis: a clinicopathological study using cluster analysis. Intern Med 2007;46:213-9.
22. Koc Y, Basturk T, Unsal A, et al. Effects of AA amyloidosis on survival in peritoneal dialysis. Kidney Blood Press Res 2012;36:182-90.
23. Green H, Lichtenberg S, Rahamimov R, et al. Familial Mediterranean Fever Is Associated With Increased Mortality After Kidney Transplantation-A 19 Years’ Single Center Experience. Transplantation 2017;101:2621-6.
24. Bulut M, Keles N, Caliskan Z, et al. Is the presence of AA amyloidosis associated with impaired coronary flow reserve? Atherosclerosis 2016;251:389-95.
25. Kukuy O, Livneh A, Ben-David A, et al. Familial Mediterranean fever (FMF) with proteinuria: clinical features, histology, predictors, and prognosis in a cohort of 25 patients. J Rheumatol 2013;40:2083-7.
26. Huzmeli C, Koçkara AS, Candan F, et al. Biopsy Proven Non-Amyloid Glomerula Diseases in Patients With Familial Mediterranean Fever. J Nephrol Res 2015;1:34-9.
27. Rodriguez RA, Cronin V, Ramsay T, et al. Reproducibility of carotid-femoral pulse wave velocity in end-stage renal disease patients: methodological considerations. Can J Kidney Health Dis 2016;3:20.
28. Langevitz P, Livneh A, Neumann L, et al. Prevalence of ischemic heart disease in patients with familial Mediterranean fever. Isr Med Assoc J 2001;3:9-12.