Association between Oxidative Stress, Cardiovascular Risk, and Disease Activity in Patients with Spondyloarthritis: A Cross-Sectional Study in a Tunisian Cohort

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Published Apr 12, 2026
https://doi.org/10.62438/tunismed.v104i03.6537
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Vol. 104 No. 03 (2026): Tunis Med Mar 2026

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Afif Ba
Biochemistry Department, Military Hospital of Tunis, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
Amira Ben Hriz
Biochemistry Department, Military Hospital of Tunis, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
Rim Dhahri
Rhumatology department, Military Hospital of Tunis, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
Mariem Belhedi
Laboratory department, Habib Thameur Hospital, Tunis, Tunisia
Manel Ayoub
Biochemistry Department, Military Hospital of Tunis, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
Sana Aboulkacem
Biochemistry Department, Military Hospital of Tunis, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
Zied Aouni
Biochemistry Department, Military Hospital of Tunis, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
C. Mazigh
Biochemistry Department, Military Hospital of Tunis, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia

Abstract

Introduction-Aim: Spondyloarthritis (SpA) is a chronic inflammatory disease associated with an increased cardiovascular (CV) risk that is not fully
explained by traditional risk factors. This study aimed to investigate the associations between oxidative stress markers, CV risk profile, and disease
activity in a Tunisian cohort of patients with SpA.
Methods: We conducted a monocentric, cross-sectional study involving 101 patients diagnosed with SpA according to the 2009 ASAS criteria.
We collected sociodemographic, clinical, and biological data. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity
Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP). The CV risk profile was evaluated
through anthropometric measurements, lipid profile, homocysteine, and the SCORE2 index. Oxidative stress status was determined by measuring
glutathione peroxidase (GPx) activity, serum levels of oligo-elements (copper, zinc, selenium).
Results: The cohort consisted of 101 patients with a mean age of 40.59 ± 11.41 years. A high prevalence of CV risk factors was observed, including
overweight/obesity (57.4%), hypertension (31.7%), atherogenic dyslipidemia (73.3%with elevatednon-HDLcholesterol), andhyperhomocysteinemia
(58.4%). Patients with active disease (ASDAS-CRP ≥ 2.1) exhibited significantly lower GPx activity (p=0.024). Serum copper levels and the copper/
zinc (Cu/Zn) ratio were significantly elevated in patients with systemic inflammation (p < 0.001). A significant negative correlation was found
between GPx activity and disease activity scores (BASDAI and ASDAS-CRP).
Conclusion: Oxidative stress is closely linked to systemic inflammation and disease activity, with decreased GPx activity and an elevated Cu/Zn ratio
emerging as potential biomarkers of inflammatory status.

Keywords:

Spondyloarthritis, Oxidative Stress, Cardiovascular Risk, Inflammation, Glutathione Peroxidase (GPx), Tunisia.

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