Cardiovascular Morbidity in Ankylosing Spondylitis: A Focus on Inflammatory Cardiac Disease

Abstract

Ankylosing spondylitis (AS) is associated with an increase in cardiovascular (CV) morbidity when compared to the general population. The increased risk of CV involvement in AS is likely multifactorial including inflammation accelerating atherosclerosis and the cardiac inflammation itself in the form of aortitis and conduction anomalies. Establishing indisputable evidence linking AS and CV disease is challenging due to AS being relatively rare and it affects 1:1,000 and all studies analyzing the association between AS and CV disease involve a small sample size making long-term outcome measurements limited. The article reviews the literature studying the association between AS and CV disease as well as the impact of therapies for AS on the CV system (CVS).

A case of ankylosing spondylitis presenting with fever of unknown origin diagnosed as aortitis: A case report

“…Aortitis is a rare but serious complication associated with AS, and its recognition is crucial for timely intervention. It is characterized by chronic inflammation of the aortic wall, which involves the aortic root and ascending aorta leading to valvular insufficiency and conduction abnormalities when extended to the interventricular septum, aneurysm formation, and potentially life‐threatening aortic dissection 1,4 . Diagnosing aortitis in the context of AS can be challenging due to the fact that symptoms of AS and the underlying systemic inflammation overlap.…”

“…4 Nevertheless, aortic involvement is considered a rare but life-threatening complication of AS, which mostly involves the aortic root and ascending aorta, that can lead to valvular insufficiency. 1,4 In this report, we present a case in which the patient, despite being young and symptomatic for only 1 year, had no evidence of peripheral arthritis, and was diagnosed with aortitis, an uncommon complication of AS.…”

“…Ankylosing Spondylitis (AS) is a chronic inflammatory rheumatic disease strongly associated with HLA B27, usually starting in the third decade of life and mostly seen in men 1–3 . It mainly affects the sacroiliac and axial joints, but other organs, such as the eyes, heart, kidneys, and lungs, have also been reported to be involved.…”

“…Ankylosing Spondylitis (AS) is a chronic inflammatory rheumatic disease strongly associated with HLA B27, usually starting in the third decade of life and mostly seen in men. [1][2][3] It mainly affects the sacroiliac and axial joints, but other organs, such as the eyes, heart, kidneys, and lungs, have also been reported to be involved. Cardiac involvement, including aortitis, aortic valve insufficiency, and cardiac conductive disorders manifests in 2%-10% of patients, increasing the morbidity of patients with AS.…”

Cardiovascular Risk in Systemic Inflammatory Arthritis

“…In recent years, several papers have been published on cardiovascular (CV) involvement, risk, management, and treatment in systemic inflammatory arthritis (SIA), including rheumatoid arthritis, (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA). An explanation for the increased interest in this topic is that although joint involvement is considered the principal manifestation of SIA, these diseases have also been associated with an enhanced burden of cardiovascular disease (CVD) [1][2][3]. Patients with SIA exhibit a higher CV risk than the general population due to an enhanced prevalence of traditional CV risk factors (hypertension, dyslipidemia, diabetes, obesity, and smoking) and the altered immuno-mediated inflammatory responses related to the diseases themselves [1][2][3][4].…”