ReviewMortality in spondylarthritis
Introduction
Ankylosing spondylitis (AS) is a chronic inflammatory joint disease that can lead to chronic pain in the axial and peripheral joints and to functional impairments after several years. Excess mortality has been reported in patients with AS. The musculoskeletal manifestations of AS include inflammatory and structural abnormalities such as syndesmophytes, erosions, vertebral fractures and fusion, sacroiliitis, and enthesitis. Some patients have peripheral arthritis. AS is a systemic disease that can cause extraarticular manifestations including aortitis, cardiac conduction disturbances, interstitial lung disease, secondary amyloidosis, inflammatory bowel disease, ocular abnormalities, and psoriasis or other skin lesions.
Several studies and review articles [1], [2] suggest excess mortality among AS patients. Excess mortality has also been documented in RA patients, although major differences exist between AS and RA populations. As with RA, the excess mortality in AS is ascribed to an increase in fatal cardiovascular events.
Here, we reviewed published data on mortality rates and causes of death among patients with AS. The available data are not yet sufficient for a comparison of standardized mortality ratios (SMRs) with and without TNFα antagonist therapy for AS.
Section snippets
Is ankylosing spondylitis associated with excess mortality?
The two main tools used to evaluate excess mortality in populations with AS are the SMR, or ratio of observed mortality on expected mortality in the general population of same age and sex distribution, and survival curve analysis. The results vary with the date and location of the studies and with changes in treatment strategies over time. In early studies, radiotherapy or intravenous radium-224 was used for pain relief. These treatments were associated with excess mortality (SMR, 1.45) related
Cardiovascular disease
Cardiovascular disease was consistently identified as the leading cause of death (Table 2), although the excess risk compared to the same-age general population was modest. Recent studies established that inflammatory joint disease was associated with an increased risk of atheroma development, perhaps related in part to the chronic systemic inflammation [11]. However, whereas systemic inflammation is often marked in RA, it is usually moderate in AS. Nevertheless, a study of 27 patients with AS
Conclusion
Our literature review does not provide clear evidence of excess mortality among AS patients not given radiotherapy. Mortality may be increased compared to the general population among AS patients with disease durations longer than 20 years. However, studies of patients followed-up into the 1990s fail to suggest a significant difference with the general population. It can be hoped that these results will be confirmed in the near future. A number of specific causes of death are responsible for
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
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