Life expectancy of someone with ankylosing spondylitis

Previous studies have shown that if you’re living with ankylosing spondylitis your vascular system (the arteries and veins that transport blood throughout the body) is at greater risk of developing disease. A new study however suggests that AS patients are also at greater risk of mortality should they develop vascular disease or experience a vascular event.

The researchers utilized data from four different Canadian registries, identifying a study cohort of 21,473 patients with AS age 15 and older. (Patients with baseline coronary artery disease or cerebrovascular disease were excluded from the study cohort.) The AS patients were compared to 86,606 persons without AS, and matched for age, sex, and location of residence.

“Recent evidence suggests that patients with AS have increased risk of vascular disease such as coronary heart disease. Our study not only strengthens this data but also provides new information that mortality after a vascular event is higher in AS patients. Further, our results suggest that vascular mortality is directly linked to AS (as comorbidities were controlled for),” said senior study author, and the 2013 recipient of SAA’s Young Investigator Award, Nigil Haroon, MD, PhD, DM.

The researchers found that patients with AS had a 43% higher risk for vascular mortality, a 60% higher risk for cerebrovascular mortality, and a 35% higher risk for cardiovascular mortality than those without AS studied for comparison. A difference in the vascular death rate was also noted between men and women who had AS – with men with AS having a 50% higher risk than men without AS, and women with AS having a 34% higher risk than women without AS. Also, with each year of advancing age the risk for vascular mortality increased by 12%.

According to Dr. Haroon, “The major clinical implication of the study is that patients with AS should be screened and closely monitored for the prevention, early diagnosis, and treatment of cardiac and coronary events.”

For further reading see:

1. Patients With Ankylosing Spondylitis Have Increased Cardiovascular and Cerebrovascular Mortality: A Population-based Study: Read more.
2. Note: Login Required For Medscape

A crucial component of SAA’s overarching mission is a commitment to expanding the number of rheumatologists and researchers in the US who focus on spondyloarthritis.

To this end, we created the Spondylitis Association Bruckel Young Investigator Award, which recognizes outstanding “contributions to the care and understanding of patients with spondyloarthritis.” SAA awards the winner a $10,000 grant for use in spondyloarthritis research. In 2013, we were thrilled to present this annual award to Nigil Haroon, MD, PhD, DM.

It’s interesting to note that the researchers found a 10% decrease in mortality risk in patients with AS associated with use of nonsteroidal anti-inflammatory drugs (NSAIDs), and a 25% reduced risk associated with use of statins.

“The decrease in risk with NSAID use may come as a surprise to the readers. We generally consider NSAIDs to increase risk of vascular events”, said Dr. Haroon. “A previous study in RA also showed [a decrease in risk with NSAID use.] Hence, in inflammatory disease, anti-inflammatories may protect patients from vascular death. However, it should be borne in mind that this might be a reflection of NSAIDs being used in the elderly population with lowest risk of vascular events.”

Like most aspects of ankylosing spondylitis, an inflammatory type of arthritis that affects nearly half a million people in the United States, according to the Arthritis Foundation, the prognosis is complicated and can be hard to predict. Some people won’t have trouble with mobility and may even see their disease come to a standstill. But for others, this form of arthritis can progress to disability.

The course of the disease is highly variable, says Eric Matteson, MD, professor emeritus of rheumatology at the Mayo Clinic in Rochester, Minnesota. “Some patients have inflammation limited to the sacroiliac joints, which doesn’t significantly impair their mobility,” he says. “Others have very extensive involvement of the spine.”

Ankylosing spondylitis causes inflammation in the sacroiliac joints, where the spine joins with the pelvis, but in severe cases, the bones in the spine can fuse together and become very stiff, Dr. Matteson explains.

One thing is true for all ankylosing spondylitis cases: Getting treated early is key. The right treatment can help slow the progression of the disease, Matteson says.

Here’s how ankylosing spondylitis could play out and what you can do about it.

Symptoms of Ankylosing Spondylitis

Ankylosing spondylitis typically comes on at a young age, often between the ages of 17 and 45, according to the Spondylitis Association of America (SAA).

Symptoms usually begin with dull back pain and stiffness that develop gradually over weeks or months, according to the SAA. A key sign of ankylosing spondylitis is pain and stiffness that’s worse in the morning or after resting but improves with exercise. And almost everyone with ankylosing spondylitis experiences flares, periods of time when pain gets worse, followed by remission, which is when symptoms subside.

Fatigue can also be a symptom because the body uses energy to deal with inflammation, according to the SAA. And early on, ankylosing spondylitis may cause a fever and loss of appetite.

Other than these factors, ankylosing spondylitis can vary widely from person to person. Some experience mild and sporadic pain, while others experience more severe pain that’s chronic. In some people, ankylosing spondylitis also affects other joints where ligaments or tendons attach to the bone, such as the hips, knees, feet, and shoulders.

Ankylosing Spondylitis Prognosis

The long-term outlook for people with ankylosing spondylitis can also vary greatly. For some, pain may be intermittent while for others it’s chronic. In some cases, ankylosing spondylitis can be debilitating and lead to disability, according to the SAA.

Over time, the inflammation associated with ankylosing spondylitis can cause the vertebrae of the spine to fuse together. In severe cases, when this happens, the spine can curve and cause a stooped position. This may also affect the ribs and make it difficult for the lungs to function properly.

As ankylosing spondylitis progresses, inflammation may affect other joints, such as the hips and shoulders, and organs, such as the bowels and eyes. Some people with ankylosing spondylitis may have Crohn’s disease or ulcerative colitis, and up to 40 percent of those with ankylosing spondylitis will develop eye inflammation, in which the eye becomes red and painful, according to the SAA.

Although ankylosing spondylitis is a progressive disease, meaning it tends to worsen as you age, it can also stop progressing in some people. Why? Doctors aren’t sure, Matteson says. However, a study published in March 2016 in Arthritis & Rheumatology found that men with ankylosing spondylitis tend to experience greater radiographic progression, erosive damage, and joint fusion compared with women with the condition.

The long-term goal for all people with ankylosing spondylitis is to maintain as much physical activity as possible without altering their daily lives.

Can Treatment Stop Ankylosing Spondylitis Progression?

Getting the right treatment early can affect how the disease plays out — treatment can improve symptoms and even slow the progression of the disease, says Matteson. Drugs used to treat ankylosing spondylitis include non-steroidal anti-inflammatory medications, methotrexate, sulfasalazine, and biologic medications, including tumor necrosis factor (TNF) inhibitors or interleukin 17 (IL-17) inhibitors. Sometimes corticosteroids are used for a limited time to treat ankylosing spondylitis.

Biologics may help slow progression of ankylosing by targeting specific proteins that promote inflammation in the body. According to research published in November 2014 in the European Journal of Clinical Investigation, people with ankylosing spondylitis that were treated with TNF inhibitors for at least four years showed evidence on MRIs that the progression of the disease had slowed. TNF inhibitors are also effective at treating the inflammation in the digestive system and eyes that’s often associated with ankylosing spondylitis, according to the SAA.

But medication isn’t the only form of relief for people with ankylosing spondylitis. Physical therapy is often also part of the treatment plan, as physical activity has been shown to significantly help with symptoms. A study published in February 2018 in The Archives of Physical Medicine and Rehabilitation found that exercise drastically improved symptoms and function in people with ankylosing spondylitis.

Whether you smoke may also affect how the disease progresses.  According to a study in the April 2017 issue of Seminars in Arthritis and Rheumatism, which looked at data from 17 studies involving approximately 5,000 adults with ankylosing spondylitis, the more people smoked, the more likely they were to report experiencing pain and problems with mobility. Plus, study participants who smoked more than 10 cigarettes a day had significantly worse health-related quality of life than people who didn’t smoke.

Some things may be out of your control when it comes to the course of ankylosing spondylitis, but there are steps you can take to protect your joints. Talk with your doctor about the right treatment plan to improve your prognosis and avoid severe joint damage.

Additional reporting by Blake Miller

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