Session Information
Date: Sunday, November 8, 2015
Session Type: ACR Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose:
There is a known association between conduction disturbances and ankylosing
spondylitis (AS). The risk of conduction disturbances in other phenotypes of spondylarthritis (SpA) is less
well studied. Studies have also indicated that SpA patients
have an increased risk of cardiovascular morbidity. Atrial fibrillation (AF) is
both an expression of cardiac disease and a risk factor for stroke. Our
objective was to investigate the incidence of atrioventricular (AV) block and
AF in patients with AS, undifferentiated spondylarthritis
(uSpA) and psoriatic arthritis (PsA)
compared to each other and to general population (GP) comparators. We also
investigated the incidence of pacemaker implantation, a possible consequence of
severe arrhythmia.
Methods:
The study design was a prospective nationwide population-based cohort study,
including an AS cohort (n=6228), an uSpA cohort
(n=4795), a PsA cohort (n=16039) and a GP cohort
(n=269815). The cohorts were identified between 2001 and 2009 in the Swedish
patient and population registers. Patients with diagnoses for more than one SpA phenotype (n=1943) were excluded. The follow-up began
January 1, 2004 or at the date of first diagnosis thereafter in previously
undiagnosed cases and extended until the first outcome occurrence, death,
emigration or December 31, 2012, whichever occurred first. Subjects with a
history of each of the outcomes of interest were excluded from the analysis of
that outcome. Number of outcomes, person-years at risk, crude rates and age-
and sexstandardized rates to the GP cohort were
calculated for each outcome and cohort. Age- and sexadjusted
hazard ratios (HRs) were calculated using Cox proportional hazard regression
analysis.
Results:
Age-and sexadjusted HRs for AV block, AF and
pacemaker implantation were significantly increased in both AS, uSpA and PsA compared to the GP
cohort. AS patients had not only a 2-fold increase in HRs for AV block and
pacemaker implantation compared to GP but also a significantly increased HR
compared to patients with PsA. The increased HR for
AV block was most pronounced for men in both the AS and uSpA
cohort, with an over 3-fold increase compared to GP comparators (Table).
|
|
AS |
uSpA |
PsA |
GP |
|
Atrioventricular block |
|
|
|
|
|
Subjects at risk, n |
6170 |
4773 |
15990 |
269125 |
|
Incident events, n |
47 |
19 |
68 |
1329 |
|
Crude rates |
1.1 (0.8-1.4) |
0.6 (0.3-0.9) |
0.6 (0.5-0.8) |
0.6 (0.5-0.6) |
|
Standardized rates* |
1.1 (0.8-1.5) |
1.2 (0.5-1.9) |
0.7 (0.5-0.9) |
na |
|
Hazard ratio† (GP as ref.) |
2.75 (2.05-3.69) |
2.71 (1.72-4.27) |
1.45 (1.14-1.86) |
1 |
|
Hazard ratio† (PsA as ref.) |
1.70 (1.16-2.49) |
1.74 (1.03-2.92) |
1 |
na |
|
Male hazard ratio# (GP as ref.) |
3.01 (2.21-4.11) |
3.77 (2.29-6.20) |
1.66 (1.23-2.23) |
1 |
|
Female hazard ratio# (GP as ref.) |
1.65 (0.68-4.00) |
1.07 (0.34-3.33) |
1.16 (0.75-1.78) |
1 |
|
Atrial fibrillation |
|
|
|
|
|
Subjects at risk, n |
5983 |
4720 |
15568 |
263558 |
|
Incident events, n |
204 |
82 |
625 |
11669 |
|
Crude rates |
5.1 (4.4-5.8) |
2.7 (2.1-3.3) |
6.2 (5.7-6.7) |
5.3 (5.2-5.4) |
|
Standardized rates* |
7.2 (5.8-8.6) |
6.1 (4.4-7.9) |
7.1 (6.5-7.7) |
na |
|
Hazard ratio† (GP as ref.) |
1.43 (1.25-1.65) |
1.26 (1.01-1.56) |
1.49 (1.38-1.62) |
1 |
|
Hazard ratio† (PsA as ref.) |
0.99 (0.84-1.17) |
0.83 (0.66-1.05) |
1 |
na |
|
Pacemaker implantation |
|
|
|
|
|
Subjects at risk, n |
6165 |
4769 |
15972 |
268806 |
|
Incident events, n |
70 |
24 |
140 |
2429 |
|
Crude rates |
1.7 (1.3-2.1) |
0.8 (0.5-1.1) |
1.3 (1.1-1.6) |
1.1 (1.0-1.1) |
|
Standardized rates* |
2.1 (1.4-2.7) |
1.5 (0.7-2.2) |
1.5 (1.2-1.7) |
na |
|
Hazard ratio† (GP as ref.) |
2.19 (1.73-2.79) |
1.76 (1.17-2.63) |
1.60 (1.35-1.90) |
1 |
|
Hazard ratio† (PsA as ref.) |
1.43 (1.07-1.93) |
1.13 (0.73-1.76) |
1 |
na |
Rates are
presented as number of events/1000 person-years. All rates and hazard ratios
are calculated with 95 % confidence interval given in parenthesis. *Age- and sexadjusted with the GP cohort as reference. †Age- and sexadjusted. #Age-adjusted.
Conclusion:
Patients with AS, uSpA and PsA
had a significantly increased risk of AV block, AF and pacemaker implantation
compared to GP comparators. Male AS and uSpA patients
had a more than 3-fold increased risk of AV-block compared to GP. These results
demonstrate both similarities and differences in subtypes of SpA, which were partly sex-specific.
To cite this abstract in AMA style:
Bengtsson K, Forsblad-d'Elia H, Lie E, Klingberg E, Dehlin M, Exarchou S, Lindström U, Askling J, Jacobsson LT. Increased Risk of Atrioventricular Block, Atrial Fibrillation and Pacemaker Implantation in Ankylosing Spondylitis, Undifferentiated Spondylarthritis and Psoriatic Arthritis Compared to the General Population [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/increased-risk-of-atrioventricular-block-atrial-fibrillation-and-pacemaker-implantation-in-ankylosing-spondylitis-undifferentiated-spondylarthritis-and-psoriatic-arthritis-compared-to-the-general-po/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-risk-of-atrioventricular-block-atrial-fibrillation-and-pacemaker-implantation-in-ankylosing-spondylitis-undifferentiated-spondylarthritis-and-psoriatic-arthritis-compared-to-the-general-po/