All-Cause and Cause-Specific Mortality in Spondyloarthritis: A Systematic Review and Meta-Analysis

Haseeb Chaudhary¹, Nidrit Bohra², Khezar Syed², Anthony Donato², M.Hassan Murad³ and Paras Karmacharya⁴, ¹Tower Health System, Reading, PA, ²Reading Hospital, Tower Health System, Reading, PA, ³Mayo Clinic, Rochester, MN, ⁴Division of Rheumatology, Mayo Clinic, Rochester, MN Division of Rheumatology, Vanderbilt University Medical Center, Nashville, TN

Meeting: ACR Convergence 2021

Keywords: Ankylosing spondylitis (AS), Epidemiology, Mortality, Psoriatic arthritis, spondyloarthritis

Session Information

Date: Sunday, November 7, 2021

Session Title: Epidemiology & Public Health Poster II: Inflammatory Arthritis – RA, SpA, & Gout (0560–0593)

Session Type: Poster Session B

Session Time: 8:30AM-10:30AM

Background/Purpose: Spondyloarthritides (SpA) represent a group of chronic inflammatory diseases associated with a higher risk of cardio-metabolic comorbidities compared to the general population. It is unclear how these comorbidities are associated with mortality in SpA, and studies on mortality in SpA have shown inconsistent results. We performed a systematic review and meta-analysis of all-cause and cause-specific mortality in psoriatic arthritis (PsA) and ankylosing spondylitis (AS).

Methods: A comprehensive database search was performed for studies reporting all-cause or cause-specific mortality in patients with PsA and AS compared with the general population. Pooled relative risks (RRs) were calculated using random-effects model.

Results: We included 19 studies (eleven for PsA, seven for AS, one for both). In PsA studies, there was no increased mortality compared to the general population (RR: 1.12, 95% CI: 0.96-1.30, 10 studies). Cardiovascular, respiratory, and infection specific mortality risks were significantly higher for PsA patients (RR: 1.21, 95% CI: 1.06-1.38; RR: 3.37, 95% CI: 1.30-8.72; and 2.43, 95% CI: 1.01-5.84, respectively). Cancer related mortality in PsA was not higher than the general population (RR: 1.01, 95% CI: 0.91-1.11). In AS, we found a higher risk of death from all causes (RR 1.64, 95% CI: 1.49-1.80, 6 studies) and cardiovascular causes compared to the general population (RR 1.35, 95% CI: 1.01-1.81, 3 studies).

Conclusion: This systematic review and meta-analysis showed a significantly increased risk of overall mortality in AS, but not PsA. Cardiovascular-specific mortality was higher for both PsA and AS, which emphasizes the importance of early screening and management of comorbidities to mitigate mortality risk.

Figure 1. Prisma Flow Diagram

Figure 2.Forrest Plot for All-cause mortality in A)Psoriatic Arthritis B)Ankylosing Spondylitis

Figure 3.Forrest plot for cause-specific mortality in psoriatic arthritis A) cardiovascular B) respiratory C) infections D) malignancy E) Injury and poisoning

Disclosures: H. Chaudhary, None; N. Bohra, None; K. Syed, None; A. Donato, None; M. Murad, None; P. Karmacharya, None.

To cite this abstract in AMA style:

Chaudhary H, Bohra N, Syed K, Donato A, Murad M, Karmacharya P. All-Cause and Cause-Specific Mortality in Spondyloarthritis: A Systematic Review and Meta-Analysis [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/all-cause-and-cause-specific-mortality-in-spondyloarthritis-a-systematic-review-and-meta-analysis/. Accessed January 28, 2023.

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