Ankylosing Spondylitis Increases Stroke Risk

Researchers sought to determine the relationship between ankylosing spondylitis and the risk for stroke.

Individuals with ankylosing spondylitis (AS) have a 56% increased risk for stroke, according to a systematic review and meta-analysis published in Reumatología Clínica.

The researchers conducted a systematic literature review of relevant studies listed in PubMed/MEDLINE and Web of Science from inception to December 2021 to better assess the association between AS and stroke. Included studies evaluated stroke risk in patients with ankylosing spondylitis, reported appropriate statistical parameters and used case-control, controlled trail or cohort study design. Data for the meta-analysis was extracted and analyzed using a DerSimonian and Laird random-effects model to estimate a pooled hazard ratio (HR) and 95% CIs. Sources of heterogeneity within the data were assessed using subgroup and meta-regression analyses.

A total of 11 studies with over 1.7 million participants and approximately 26,000 cases of stroke were identified. The pooled analyses found a significantly higher risk for stroke in patients with ankylosing spondylitis (HR=1.56; 95% CI, 1.33-1.79; P <.001). In the subgroup analyses, there was a higher risk for ischemic stroke in patients with AS (HR=1.46; 95% CI, 1.23-1.68), while only one study found an increased risk for hemorrhagic stroke. There was no association between stroke and length of follow-up, study country, or year of publication, according to the meta-regression analyses.

Limitations of the study included variable sample sizes, patient characteristics, and outcome definitions between studies. Only 2 studies reported hemorrhagic stroke results.

The study authors concluded, “This study suggests that ankylosing spondylitis significantly increases the risk of stroke. Management of cerebrovascular risk factors and control of systemic inflammation should be considered in patients with ankylosing spondylitis.”


Srikanth Bhagavathula A, Bentley BL, Woolf B, Dissanayaka TD, Rahmani J. Increased risk of stroke among patients with ankylosing spondylitis: Asystematic review and meta-analysis. Reumatología Clínica. Published online June 5, 2022. doi: 10.1016/j.reuma.2022.04.001