Risk of Cardiac Disease in Patients With Spondyloarthropathies

April 10, 2018

A study sheds new light on the extra-articular manifestations of spondyloarthritis-with a focus on the heart as a high-risk target.

Reference1. Bengtsson K, Forsblad-d’Elia H, Lie E, et al. Risk of cardiac rhythm disturbances and aortic regurgitation in different spondyloarthritis subtypes in comparison with general population: a register-based study from Sweden. Ann Rheum Dis. 2018;77:541-548.

Researchers in Sweden examined a large national database to look for associations between ankylosing spondylitis, undifferentiated spondyloarthritis, and psoriatic arthritis-and cardiac rhythm disturbances and aortic valve regurgitation.¹ Scroll through the slides for their findings and take-home points for clinicians.
(©Radu Berkan/Shutterstock.com)

Studies that have looked at cardiac manifestations in ankylosing spondylitis have been small and inconsistent. The risk of atrial fibrillation has not been studied sufficiently in spondyloarthritis.

What is the incidence of atrioventricular (AV) block type II and III, atrial fibrillation, and aortic regurgitation in patients with ankylosing spondylitis, psoriatic arthritis, and undifferentiated spondyloarthritis compared with the general population?

What risk do patients with spondyloarthropathies have of needing a pacemaker implantation because of a severe arrhythmia?

A large sample was collected between 2001 and 2009, with follow-up beginning in 2006 and ending in 2012 unless cardiac rhythm disturbances, aortic regurgitation, or pacemaker implantation was recorded. Incidence rates and hazard ratios were calculated.

Incidence rates for type II and III AV heart block in ankylosing spondylitis, undifferentiated spondyloarthritis, and psoriatic arthritis were 0.9, 1.2, and 0.7 events per 1000 person-years, compared with 0.5 in the general population.

The age- and sex-adjusted hazard ratios (HRs) (95% CI) were significantly increased in ankylosing spondylitis (2.3 [1.6 to 3.3]), undifferentiated spondyloarthritis (2.9 [1.8 to 4.7]), and psoriatic arthritis (1.5 [1.1 to 1.9]), compared with the general population cohort. In the sex-stratified analyses, the highest age-adjusted HR point estimates were noted for male patients with undifferentiated spondyloarthritis (4.2 [2.5 to 7.0]) and ankylosing spondylitis (2.5 [1.7 to 3.7]), compared with the male general population cohort.

Incidence rates for atrial fibrillation in ankylosing spondylitis, undifferentiated spondyloarthritis, and psoriatic arthritis were 7.1, 6.4, and 7.4 events per 1000 person-years, compared with 5.5 in the general population.

The age- and sex-adjusted hazard ratios (95% CI) were significantly increased in ankylosing spondylitis (1.3 [1.2 to 1.6]), undifferentiated spondyloarthritis (1.3 [1.0 to 1.6]) and psoriatic arthritis (1.5 [1.3 to 1.6]), compared with the general population cohort.

Incidence rates for pacemaker placement in ankylosing spondylitis, undifferentiated spondyloarthritis, and psoriatic arthritis were 2.0, 1.5, and 1.5 events per 1000 person-years, compared with 1.0 in the general population.

The age- and sex-adjusted hazard ratios (HRs) (95% CI) were significantly increased in ankylosing spondylitis (2.1 [1.6 to 2.8]), undifferentiated spondyloarthritis (1.9 [1.2 to 2.9]), and psoriatic arthritis (1.6 [1.3 to 1.9]).

In the sex-stratified analyses, the highest age-adjusted HR point estimate was noted for male patients with undifferentiated spondyloarthritis (2.9 [1.8 to 4.6]).

A significantly increased age- and sex-adjusted HR was noted in ankylosing spondylitis (1.5 [1.0 to 2.1]), compared with psoriatic arthritis.

Incidence rates for aortic regurgitation in ankylosing spondylitis, undifferentiated spondyloarthritis, and psoriatic arthritis were 0.7, 0.7, and 0.7 events per 1000 person-years, compared with 0.4 in the general population.

The age- and sex-adjusted hazard ratios (95% CI) were significantly increased in ankylosing spondylitis (1.9 [1.3 to 2.9]), undifferentiated spondyloarthritis (2.0 [1.2 to 3.5]), and psoriatic arthritis (1.8 [1.4 to 2.4]).

The results of this study shed new light on the extra-articular manifestations of spondyloarthritis. As in other forms of inflammatory disease, the heart is at particularly high risk as a comorbid target of the inflammatory process.

These results confirm the previously known association between ankylosing spondylitis and conduction disturbances and aortic regurgitation, as well as the association with the other spondyloarthropathies, especially undifferentiated spondyloarthritis and to a lesser extent psoriatic arthritis.

In the sex-stratified analyses, the risk of AV block was elevated in male but not female patients, compared with general population, and was especially elevated in male patients with ankylosing spondylitis or undifferentiated spondyloarthritis.