Cardiovascular Risk May Be Increased in Patients With axSpA and Extra-Articular Manifestations

Researchers studied the effect of extra-articular manifestations on disease characteristics and cardiovascular risk in patients with axial spondyloarthritis.

Patients with axial spondyloarthritis (axSpA) have an increased cardiovascular (CV) risk in the presence of extra-articular manifestations (EAMs), according to the results of a cross-sectional study published in Seminars of Arthritis and Rheumatism.  

In addition to displaying disease-related features, patients with axSpA and EAMs tend to have an increased CV risk that may be proportional to the number of EAMs and proatherogenic factors other than the traditional CV risk factors, including the use of glucocorticoids and inflammatory load.

In the current study, the researchers sought to establish the potential impact of EAMs on specific disease characteristics in patients with axSpA. 

Study data, including history of CV events, subclinical atherosclerosis, and other disease-linked features, were collected from the AtheSpA cohort, a Spanish multicenter study that explored the development of atherosclerosis in patients with axSpA.

Researchers analyzed information on the history of EAMs, including psoriasis, inflammatory bowel disease (IBD), and acute anterior uveitis (AAU), which were diagnosed by dermatologists, gastroenterologists, and ophthalmologists, respectively, or by general practitioners.

A total of 888 patients with axSpA were enrolled in the study, among whom 593 did not have concomitant EAMs; however, coexisting AAU, psoriasis, and IBD were reported in 19.9% (n=177), 10.8% (n=96), and 6.4% (n=57) of participants, respectively.

Results of the study showed a significant increase in prior CV events among patients with psoriasis (9% vs 4%, respectively; P =.048), as well as in those with at least 1 or 2 EAMs (7% vs 4%, respectively; P =.032 and 11% vs 4%, respectively; P =.022).

The frequency of carotid plaques and intima-media wall thickness (IMT) were higher among patients with vs without EAMs; however, the univariable analysis for carotid plaques in patients with psoriasis (39% vs 30%, respectively; P =.038), as well as for carotid IMT in those with AAU (665±156 vs 637±139 μm, respectively; P =.042) and those with at least 1 EAM (661±155 vs 637±139 μm, respectively; P =.024), demonstrated statistically significant results.

Further, patients with psoriasis and IBD vs those without EAMs were shown to have more specific disease characteristics, including higher erythrocyte sedimentation rates at axSpA diagnosis, and more frequent use of glucocorticoids and tumor necrosis factor inhibitors (TNFi).

Compared with participants without EAMs, those with psoriasis reported peripheral involvement more often, and those with AAU had more severe radiographic damage. The frequency of human leukocyte antigen B27 (HLA B27) was higher among individuals with AAU and lower among those with psoriasis and IBD compared with those without EAMs.

Limitations included the cross-sectional and multicentric design of the study, primarily related to the collection of observer-dependent data, including the presence of subclinical atherosclerosis.

The study authors concluded, “The present study contributes to better characterizing patients [with with concomitant EAMs, highlighting differences in the degree of the inflammatory response and the HLA B27 status, as well as in the peripheral involvement in patients with [psoriasis], or the radiographic damage in [patients with] AAU.”


Rueda-Gotor J, Ferraz-Amaro I, Genre F, et al. Cardiovascular and disease-related features associated with extra-articular manifestations in axial spondyloarthritis. A multicenter study of 888 patients. Semin Arthritis Rheum. Published online September 9, 2022. doi:10.1016/j.semarthrit.2022.152096