Background/Purpose: Comorbidities, both related and unrelated to the concept of spondyloarthritis (SpA), are common in patients with ankylosing spondylitis (AS) and may have substantial influence on health outcomes. However, data on the prevalence of these comorbidities in AS vary substantially. Objective of the study was to review the literature on the prevalence of SpA-related comorbidities uveitis, psoriasis and inflammatory bowel disease (IBD), as well as on prevalence of osteoporosis and vertebral fractures in patients with AS.

Methods: Medline, Embase and Cochrane were searched systematically up to November 2011, supplemented by a hand search of references. Specific MeSH headings and key words were used to identify all relevant studies without restriction of languages. Articles were eligible if reporting original data on the prevalence of one of the above mentioned comorbidities in studies on adult patients with AS. Study quality was assessed independently by 2 authors using a predefined criteria list. Demographic and prevalence data were extracted and studies were combined to express prevalence with 95% confidence intervals (CI) weighted for the number of patients included in the studies.

Results: Out of 7817 studies initially retrieved, 188 met the inclusion criteria. Additionally, 13 studies were found by hand search. The prevalence of uveitis, psoriasis, IBD, osteoporosis and vertebral fractures could be calculated in respectively 137 (40141 patients), 53 (25695 patients), 66 (30410 patients), 24 (2786 patients), and 17 articles (2285 patients). The overall (weighted) mean age was 43.9 (SD 6.9) years, mean disease duration 16.7 (SD 6.2) years and 63.7% were men. The weighted prevalence of uveitis was 30.3% (95% CI 30.2-30.4) for a mean disease duration of 16.4 (SD 6.4) years but increased with longer disease duration (from 19.4% for a disease duration of <10 years to 36.5% for a duration of >20 years). Prevalence of uveitis was also higher for studies using self-report compared to medical records (39.2% vs. 27.4%, p<0.001). Weighted prevalence of psoriasis was 11.3% (95% CI 11.2-11.4) for a mean disease duration of 18.0 (SD 6.3) years and prevalence of IBD was 7.2% (95% CI 7.1-7.2) for a mean disease duration of 17.8 (SD 6.4) years, without a clear relation to disease duration for both comorbidities. Prevalence of osteoporosis was 20.5% (19.4-21.6) in the lumbar spine, 10.9% (10.4-11.4) at the femoral neck and 29.2% (28.2-30.1) at both anatomical sites for a mean disease duration of 12.4 (SD 5.2) years in studies that screened for radiological evidence. The overall prevalence of osteoporosis increased with longer disease duration. Osteoporosis was diagnosed in 3.4% according to medical records data (936 patients). Vertebral fractures were present on 21.8% (21.0-22.4) of the radiographs for a mean disease duration of 19.5 (SD 6.1) years, and prevalence was 5.8% in studies using self-report (1071 patients).

Conclusion: SpA-related comorbidities, osteoporosis and vertebral fractures are very common in patients with AS but may vary with disease duration and method of investigation. Given the high prevalence, attention for comorbidities in relation to outcome in AS is recommended.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-spondyloarthritis-related-comorbidities-osteoporosis-and-fractures-in-ankylosing-spondylitis-a-systematic-literature-review/