Abstract
ABSTRACTObjective To investigate the prevalence of electrocardiographic changes in patients with spondyloarthritis and to correlate these changes with use of anti-tumor necrosis factor-alpha (TNF-α) drugs and HLA-B27 positivity.Methods Retrospective study including 100 patients diagnosed with spondyloarthritis according to Assessment of SpondyloArthritis International Society (ASAS) criteria and 50 controls. Epidemiological and clinical features, results of inflammatory activity tests, HLA-B27 positivity, and medication use data were extracted from medical records. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). All participants were submitted to electrocardiogram performed using a 12-lead device; rhythm, heart rate, conduction disorders and QT interval corrected using the Bazett formula were analyzed.Results Of 100 patients with spondyloarthritis, 51 were on anti-TNF-α drugs and 49 were not. HLA-B27 was detected in 53.1% of patients in the sample. Patients with spondyloarthritis had lower heart rate (p=0.06), longer QT interval (p<0.0001) and higher prevalence of right bundle branch block (p=0.014) compared to controls. Duration of disease was weakly correlated with heart rate (Rho=0.26; 95%CI: 0.06-0.44; p=0.008). The prevalence of right bundle branch block was positively correlated with HLA-B27 positivity. Use of Anti-TNF-α drugs did not interfere with electrocardiographic parameters.Conclusion Patients with spondyloarthritis had lower heart rate, longer QT interval and a higher prevalence of right bundle branch block compared to controls. HLA-B27 positivity was associated with the prevalence of right bundle branch block. Anti-TNF-α drugs had no impact on electrocardiographic findings.
Highlights
Spondyloarthritis (SpA) comprise a group of chronic diseases including ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), juvenile SpA, inflammatory bowel disease-related SpA and undifferentiated spondyloarthritis.(1,2) Major complaints associated with SpA are of musculoskeletal origin; several extra-articular manifestations have been reported, including cardiac conditions such as aortitis, aortic insufficiency, conduction disorders and atrioventricular blocks,(1) which are thought to affect approximately 10% of patients
First-degree atrioventricular blocks (AVBs) are associated with an increased risk of atrial fibrillation (AF),(5) which in turn is associated with stroke, heart failure and increased mortality.(6)
This study revealed lower heart rates, increased prevalence of Incomplete rigth bundle branch blocks (IRBBB), and higher QT intervals were corrected (QTc) values in patients suffering from SpA compared to controls
Summary
Spondyloarthritis (SpA) comprise a group of chronic diseases including ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), juvenile SpA, inflammatory bowel disease-related SpA and undifferentiated spondyloarthritis.(1,2) Major complaints associated with SpA are of musculoskeletal origin; several extra-articular manifestations have been reported, including cardiac conditions such as aortitis, aortic insufficiency, conduction disorders and atrioventricular blocks,(1) which are thought to affect approximately 10% of patients. Cardiac involvement is often subclinical, associated with longstanding disease(1,3) and unrelated to articular disease activity.(1) Pacemaker implantation and valve replacement may be required in severe cases.(4) Ankylosing spondylitis is the best understood SpA in terms of cardiac manifestations, which include atrioventricular blocks (AVBs), arrhythmias and ventricular dysfunction due to fibrosis. In that study, prolonged P wave duration and dispersion were associated with inflammatory activity, as measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)
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