Comorbidities in Spondyloarthritis

Abstract

Comorbidities in spondyloarthritis (SpA) add to the burden of disease by contributing to disease activity, functional and work disability, and mortality. Thus, awareness of comorbidities in SpA is crucial to improve their screening and management and to ultimately improve outcomes in those affected. Osteoporosis has been reported to be the most prevalent comorbidity in SpA, and its risk is increased in these patients, compared with the general population; the risk of vertebral fractures requires further evaluation. Cardiovascular risk is also increased in this population, both due to an increase of the traditional cardiovascular risk factors in these patients, but also due to the presence of inflammation. The role of non-steroidal anti-inflammatory drugs in this increased risk needs further elucidation, but there is consensus on the need to encourage smoking cessation and to perform periodic evaluation of cardiovascular risk in these patients, particularly in the case of change in treatment course. Concerning the risk of cancer, no increased risk inherent to SpA seems to exist. However, an increased neoplastic risk can occur due to SpA treatments, e.g., P-UVA. Data are sparse on the risk of infections compared with rheumatoid arthritis, but there appears to be no risk in the absence of TNF-inhibitor exposure. Regardless of which comorbidity, a gap exists between recommendations for their management and actual implementation in clinical practice, suggesting that there is still a need for improvement in this area. Systematic screening for these comorbidities should improve both short- and long-term outcomes in SpA patients.

Recognizing Axial Spondyloarthritis: A Guide for Primary Care

“…Patients with axSpA frequently have extra-articular manifestationsdincluding uveitis, psoriasis, and inflammatory bowel disease (IBD)dand additional comorbidities associated with axSpA such as fatigue, osteoporosis, cardiovascular disease, and sleep apnea. 19,[31][32][33][34][35][36] The most common extraarticular manifestation in axSpA is anterior uveitis, which affects 25% to 35% of patients. Uveitis in axSpA is typically acute and unilateral and can be self-limited; recurrence is common and may occur in the alternate eye.…”

Work Disability in Axial Spondyloarthritis

“…A number of other conditions can also co-exist with axSpA, classically referred to as comorbidities. These include metabolic bone and cardiovascular disease [6][7][8] which further contribute to the complexity of patients, challenging their management and outcomes. AxSpA has been associated with severe physical limitation, functional impairment and decreased quality of life [9,10].…”

Multi-omics Analysis at Serum Proteomic and Metabolomic Levels Reveals Mechanisms of Moxibustion for a Mouse Model of Ankylosing Spondylitis

“…APOB and APOC were the main protein components of low-density lipoproteins (LDL) and very low density lipoproteins (VLDL), respectively, and they were important biomarkers for predicting the cardiovascular (CV) risks [76]. It has been reported that the CV event is the leading cause of mortality in AS, which is partly due to the dyslipidemia in AS patients, including high levels of APOB and APOC [77]. Previously, Huang et al [78] reported that plasma levels of APOB and APOC markedly decreased in the hyperlipidemia rabbit model and increased following herbal-partitioned moxibustion.…”