Complications of axial spondyloarthritis

Mapping Intimacies ◽

10.1093/med/9780198755296.003.0009 ◽

2016 ◽

Author(s):

Stefan Siebert ◽

Sengupta Raj ◽

Alexander Tsoukas

Keyword(s):

Ankylosing Spondylitis ◽

Cardiovascular Events ◽

Axial Spondyloarthritis ◽

Spinal Fractures ◽

Neurological Complications ◽

Cardiac Complications ◽

Minor Trauma ◽

Conduction Disturbances ◽

Increased Risk ◽

Mechanical Constraint

In addition to the well-recognized extra-articular manifestations (EAMs) of ankylosing spondylitis (AS), this condition can also be associated with a number of clinically important complications. While EAMs are considered part of the spondyloarthritis (SpA), the complications are generally a consequence of having the disease. Patients with AS are at increased risk of osteoporosis and spinal fractures. The latter may occur after seemingly minor trauma and may lead to significant neurological compromise. Other potential neurological complications include atlantoaxial subluxation and compressive radiculopathy or myelopathy. Cardiac complications include cardiovascular events, valvular disease, and conduction disturbances. Pulmonary disease in AS relates to parenchymal involvement or mechanical constraint from chest wall inflammation. Renal disease is generally rare in AS.

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Potential relation of cardiovascular risk factors to disease activity in patients with axial spondyloarthritis

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x211033755 ◽

2021 ◽

Vol 13 ◽

pp. 1759720X2110337

Author(s):

Iván Ferraz-Amaro ◽

Javier Rueda-Gotor ◽

Fernanda Genre ◽

Alfonso Corrales ◽

Ricardo Blanco ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Axial Spondyloarthritis ◽

Multivariable Analysis ◽

Activity Score ◽

Increased Risk ◽

Activity Measurements ◽

Beta Coefficient

Background: Axial spondyloarthritis (axSpA) patients are known to have a higher prevalence of several comorbidities, including, among others, an increased risk of atherosclerosis, hypertension, dyslipidemia, and diabetes. The purpose of the present study was to determine whether the sum of traditional cardiovascular (CV) risk factors is related to disease characteristics, such as disease activity, in patients with axSpA. Methods: A cross-sectional study that encompassed 804 patients with axSpA was conducted. Patients were assessed for the presence of five traditional CV risk factors (diabetes mellitus, dyslipidemia, hypertension, obesity, and smoking status), and disease activity measurements. A multivariable regression analysis was performed to evaluate whether the number of classic CV risk factors was independently associated with specific features of the disease, to include disease activity. Results: A multivariable analysis showed that Ankylosing Spondylitis Disease Activity Score–C reactive protein (ASDAS-CRP) activity score was significantly higher in patients with 1 [beta coefficient 0.3 (95% confidence interval (CI) 0.1–0.5), p = 0.001] and ⩾2 [beta coefficient 0.5 (95% CI 0.3–0.7), p = 0.000] CV risk factors compared with those without CV risk factors. Similarly, patients with 1 [OR 2.00 (95%CI 0.99–4.02), p = 0.053] and ⩾2 [OR 3.39 (95%CI 1.82–6.31), p = 0.000] CV risk factors had a higher odds ratio for the presence of high disease activity compared with the zero CV category. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) activity score was significantly associated with the number of CV risk factors, being higher in patients with more CV risk factors. These relationships showed a CV risk factor-dependent effect being beta coefficients and ORs higher for the effect of ⩾2 over 1 CV risk factor. Conclusion: Among patients with axSpA, as the number of traditional CV risk factors increased, disease activity similarly increases in an independent manner.

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First-Ever Ischemic Stroke and Incident Major Adverse Cardiovascular Events in 93 627 Older Women and Men

Stroke ◽

10.1161/strokeaha.119.028066 ◽

2020 ◽

Vol 51 (2) ◽

pp. 387-394 ◽

Cited By ~ 5

Author(s):

Luciano A. Sposato ◽

Melody Lam ◽

Britney Allen ◽

Salimah Z. Shariff ◽

Gustavo Saposnik ◽

...

Keyword(s):

Sex Differences ◽

Heart Disease ◽

Ischemic Stroke ◽

Cardiovascular Events ◽

Population Based ◽

Major Adverse Cardiovascular Events ◽

Cardiac Complications ◽

Coronary Syndrome ◽

Cardiovascular Comorbidities ◽

Increased Risk

Background and Purpose— Stroke risk is sex-specific, but little is known about sex differences of poststroke major adverse cardiovascular events (MACEs). Stroke-related brain damage causes autonomic dysfunction and inflammation, sometimes resulting in cardiac complications. Sex-specific cardiovascular susceptibility to stroke without the confounding effect of preexisting heart disease constitutes an unexplored field because previous studies focusing on sex differences in poststroke MACE have not excluded patients with known cardiovascular comorbidities. We therefore investigated sex-specific risks of incident MACE in a heart disease-free population-based cohort of patients with first-ever ischemic stroke and propensity-matched individuals without stroke. Methods— We included Ontario residents ≥66 years, without known cardiovascular comorbidities, with first-ever ischemic stroke between 2002 and 2012 and propensity-matched individuals without stroke. We investigated the 1-year risk of incident MACE (acute coronary syndrome, myocardial infarction, incident coronary artery disease, coronary revascularization procedures, incident heart failure, or cardiovascular death) separately for females and males. For estimating cause-specific adjusted hazard ratios, we adjusted Cox models for variables with weighted standardized differences >0.10 or those known to influence MACE risk. Results— We included 93 627 subjects without known cardiovascular comorbidities; 21 931 with first-ever ischemic stroke and 71 696 propensity-matched subjects without stroke. Groups were well-balanced on propensity-matching variables. There were 53 476 women (12 421 with and 41 055 without ischemic stroke) and 40 151 men (9510 with and 30 641 without ischemic stroke). First-ever ischemic stroke was associated with increased risk of incident MACE in both sexes. The risk was time-dependent, highest within 30 days (women: adjusted hazard ratio, 25.1 [95% CI, 19.3–32.6]; men: aHR, 23.4 [95% CI, 17.2–31.9]) and decreasing but remaining significant between 31 and 90 days (women: aHR, 4.8 [95% CI, 3.8–6.0]; men: aHR, 4.2 [95% CI, 3.3–5.4]), and 91 to 365 days (aHR, 2.1 [95% CI, 1.8–2.3]; men: aHR, 2.0 [95% CI, 1.7–2.3]). Conclusions— In this large population-based study, ischemic stroke was independently associated with increased risk of incident MACE in both sexes.

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Neurological complications of ankylosing spondylitis

Journal of Neurosurgery ◽

10.3171/jns.1993.78.6.0871 ◽

1993 ◽

Vol 78 (6) ◽

pp. 871-878 ◽

Cited By ~ 121

Author(s):

Mark W. Fox ◽

Burton M. Onofrio ◽

John E. Kilgore

Keyword(s):

Ankylosing Spondylitis ◽

Spinal Column ◽

Spinal Fractures ◽

Neurological Complications ◽

Neurological Deficits ◽

Successful Outcome ◽

Spinal Instability ◽

Spinal Disorders ◽

Content Type ◽

Fine Print

✓ Thirty-three patients with ankylosing spondylitis with or without spinal neurological symptoms requiring surgical intervention were identified in a retrospective review of all cases of spinal disorders treated at the Mayo Clinic during the period from 1984 to 1989. Spinal fractures (traumatic or pseudoarthroses), progressive spinal deformity, rotary instability secondary to atlanto-occipital or atlantoaxial subluxation, and spinal stenosis with associated neurological deficit, pain, or spinal instability were the most common indications for surgery. Of the 41 operations performed, there were 17 cervical, 14 thoracic, and 10 lumbar procedures. Eight patients had two or more disorders at separate spinal levels that required surgery. Preoperative neurological deficits were recorded in 13 patients: these improved following surgery in nine and stabilized in four. This review emphasizes the fragility of the ankylosed spinal column and its inherent susceptibility to fracture with attendant neurological compromise. It also identifies the variety of spinal disorders observed in these patients and discusses their surgical management. The experience with this series suggests that thorough radiological evaluation, extreme caution with endotracheal intubation and with halo-vest applications, early surgical spinal immobilization, and aggressive postoperative mobilization of patients are necessary for a successful outcome. It is concluded that outcomes in these patients can be favorable when managed appropriately.

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Clinical features and predictors for mortality in patients with infective endocarditis at a university hospital in Taiwan from 1995 to 2003

Epidemiology and Infection ◽

10.1017/s0950268805005224 ◽

2005 ◽

Vol 134 (3) ◽

pp. 589-597 ◽

Cited By ~ 16

Author(s):

C.-N. HSU ◽

J.-Y. WANG ◽

C.-D. TSENG ◽

J.-J. HWANG ◽

P.-R. HSUEH ◽

...

Keyword(s):

Infective Endocarditis ◽

Clinical Features ◽

Elevated Serum ◽

Neurological Complications ◽

University Hospital ◽

Cardiac Complications ◽

Coagulase Negative Staphylococci ◽

Underlying Malignancy ◽

Increased Risk ◽

Wbc Count

The clinical features and microbiological characteristics of 315 patients with definite or possible infective endocarditis (IE) from January 1995 to December 2003 were evaluated. There were 187 males and 128 females with a mean age of 51 years (range, 1 month to 92 years). Ninety-three patients (30%) had a diagnosis of valvular heart disease and 24 (8%) had received prosthetic valve replacement. Blood culture was negative in 62 patients (20%). Staphylococci (91 patients, 32%), including methicillin-susceptible Staphylococcus aureus (15%), methicillin-resistant S. aureus (11%), and coagulase-negative staphylococci (6%), were the most commonly encountered pathogens followed by viridans group streptococci (77 patients, 24%). Eight patients (25%) had various neurological, renal, embolic, and cardiac complications. Patients with neurological complications [odds ratio (OR) 8·175, P<0·001], nosocomial IE (OR 6·661, P<0·001), underlying malignancy (OR 4·993, P<0·001), elevated serum creatinine level (OR 3·132, P=0·001), or elevated WBC count (>15000/mm3) (OR 2·537, P=0·007) were at significantly increased risk of mortality. This study found mortality from IE was associated with several factors, among which neurological complications were the most hazardous. Patients with more than one risk factor had poorer prognosis. These results suggest the need for more aggressive management in patients with IE when multiple risk factors for mortality are identified.

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Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study

Arthritis Research & Therapy ◽

10.1186/s13075-017-1315-z ◽

2017 ◽

Vol 19 (1) ◽

Cited By ~ 42

Author(s):

Karin Bengtsson ◽

Helena Forsblad-d’Elia ◽

Elisabeth Lie ◽

Eva Klingberg ◽

Mats Dehlin ◽

...

Keyword(s):

Cohort Study ◽

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Cardiovascular Events ◽

Population Based ◽

Undifferentiated Spondyloarthritis ◽

Increased Risk

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The role of bone morphogenetic proteins in ankylosing spondylitis

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x12444175 ◽

2012 ◽

Vol 4 (4) ◽

pp. 293-299 ◽

Cited By ~ 17

Author(s):

Shea Carter ◽

Kirsten Braem ◽

Rik J. Lories

Keyword(s):

Ankylosing Spondylitis ◽

Bone Formation ◽

Bone Morphogenetic Proteins ◽

Drug Targets ◽

Spinal Fractures ◽

Axial Skeleton ◽

Spinal Mobility ◽

Endochondral Bone Formation ◽

New Bone Formation ◽

Increased Risk

Ankylosing spondylitis (AS), the best-known form of spondyloarthritis (SpA), is a remodelling arthritis characterized by chronic inflammation and bone formation. Ankylosis of the axial skeleton and sacroiliac joints leads to an impairment of spinal mobility, progressive spinal fusion and an increased risk of spinal fractures. The nature of the relationship between inflammation and new bone formation in AS has been controversial and questions remain as to whether there is a direct relationship between inflammation and new bone formation. Like others, we have hypothesized that the molecular pathways underlying ankylosis recapitulate the process of endochondral bone formation and that bone morphogenetic proteins (BMPs) play a key role in this process in AS. Furthermore, we discuss the entheseal stress hypothesis, which proposes that inflammation and ankylosis are linked but largely independent processes, and consider observations from mouse models and other human diseases which also imply that biomechanical factors contribute to the pathogenesis of AS. As current therapeutics, such as tumour necrosis factor inhibitors do not impede disease progression and ankylosis in AS, it is the pathways discussed in this review that are the now the focus for the identification of future drug targets.

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