Abstract
The knowledge of the development of comorbidities in patients with ankylosing spondylitis (AS) is limited. The aim of this study was to analyse associations between AS disease characteristics and comorbidity and to evaluate patterns of comorbidities in patients with AS. Patients with AS, fulfilling the modified New York Criteria, were identified (n = 346, mean age 56 ± 15 years, 75% men, 99% HLA B27 positive). Through a review of the patient records, data on disease activity parameters, laboratory results, disease manifestations, and diagnoses of any clinically significant comorbidity was obtained. Four categories of comorbidities of interest were identified: A. arrhythmias, conduction disorders, and valvular heart disease; B. atherosclerosis and atherosclerotic CVD; C. spinal and non-spinal fractures; and D. obstructive sleep apnoea syndrome. Associations between AS disease characteristics and comorbidities in categories were assessed in logistic regression models. Differences in proportions of comorbidities was analysed using two-sided chi-square. Age was associated with all four categories of comorbidities, and male sex with arrhythmias, conduction disorders, valvular heart disease, and obstructive sleep apnoea syndrome. Early disease onset and long disease duration, respectively, were associated with arrhythmias, conduction disorders, and valvular heart disease. Obstructive sleep apnoea syndrome was associated with features of the metabolic syndrome. Patients with atherosclerotic cardiovascular disease had an increased risk of most other comorbidities, similar to, but more pronounced than patients with arrhythmias, conduction disorders and valvular heart disease. Comorbid conditions motivate clinical awareness among patients with AS. Longitudinal studies are needed to establish preventive measures.
Highlights
Ankylosing spondylitis (AS) is a chronic inflammatory disease, primarily involving the axial skeleton and entheses [1]
Like anterior uveitis, inflammatory bowel disease, and psoriasis, might be considered as phenotypic features of the AS disease as such [3, 4]. This might be the case for aortic regurgitation and cardiac conduction system disorders, and possibly osteoporosis and spinal fractures, which all are related to the disease [5,6,7,8,9,10]
Patients with obstructive sleep apnoea syndrome (OSAS) had a higher proportion of features of the metabolic syndrome—diabetes, dyslipidaemia, and hypertension (Fig. 1). In this cross-sectional study, exploring patterns of comorbidity in patients with established AS, we observed cardiovascular disease (CVD), arrhythmias and valvular heart disease, fractures and OSAS to be associated with age, and arrhythmias and valvular heart disease to be associated with long disease duration, and low age at AS disease onset
Summary
Ankylosing spondylitis (AS) is a chronic inflammatory disease, primarily involving the axial skeleton and entheses [1]. The clinical characteristics of AS, such as the risk of progressive spinal stiffness, are well known, but the total burden of the disease, taking comorbidity into account, has been less studied. Like anterior uveitis, inflammatory bowel disease, and psoriasis, might be considered as phenotypic features of the AS disease as such [3, 4]. This might be the case for aortic regurgitation and cardiac conduction system disorders, and possibly osteoporosis and spinal fractures, which all are related to the disease [5,6,7,8,9,10].
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