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Meta-Analysis
. 2023 May;75(5):1052-1065.
doi: 10.1002/acr.24820. Epub 2023 Jan 19.

All-Cause and Cause-Specific Mortality in Psoriatic Arthritis and Ankylosing Spondylitis: A Systematic Review and Meta-Analysis

Haseeb Chaudhary  1 , Nidrit Bohra  1 , Khezar Syed  1 , Anthony Donato  1 , M Hassan Murad  2 , Paras Karmacharya  3
Affiliations
Meta-Analysis

All-Cause and Cause-Specific Mortality in Psoriatic Arthritis and Ankylosing Spondylitis: A Systematic Review and Meta-Analysis

Haseeb Chaudhary et al. Arthritis Care Res (Hoboken). 2023 May.

Abstract

Objective: Psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are chronic inflammatory diseases associated with a higher risk of cardiometabolic comorbidities compared to the general population. Individual studies examining mortality in these patients have produced conflicting results. The present study was undertaken to perform a systematic review and meta-analysis to analyze the all-cause and cause-specific mortality in PsA and AS from the available literature.

Methods: A comprehensive database search was performed for studies reporting all-cause or cause-specific mortality in patients with PsA and AS compared with the general population. Pooled relative risks (RRs) were calculated using a random-effects model.

Results: We included 19 studies (11 of PsA, 7 of AS, 1 of both). In PsA studies, there was no increased mortality compared to the general population (RR 1.12 [95% confidence interval (95% CI) 0.96-1.30]; n = 10 studies). We found a higher all-cause mortality in female (RR 1.19 [95% CI 1.04-1.36]) but not in male (RR 1.02 [95% CI 0.66-1.59]) PsA patients. Cardiovascular-, respiratory-, and infection-specific mortality risks were significantly higher for PsA patients (RR 1.21 [95% CI 1.06-1.38], RR 3.37 [95% CI 1.30-8.72], and RR 2.43 [95% CI 1.01-5.84], respectively), but not cancer-related mortality (RR 1.01 [95% CI 0.91-1.11]). In AS, we found a higher risk of death from all causes (RR 1.64 [95% CI 1.49-1.80]; n = 6 studies) and cardiovascular causes (RR 1.35 [95% CI 1.01-1.81]; n = 3 studies) compared to the general population. All-cause mortality was high in both male (RR 1.56 [95% CI 1.43-1.71]) and female (RR 1.85 [95% CI 1.56-2.18]) AS patients. The included AS studies did not report mortality data for non-cardiovascular causes.

Conclusion: This systematic review and meta-analysis showed a significantly increased risk of overall mortality in AS but not PsA. Cardiovascular-specific mortality was higher for both PsA and AS, which emphasizes the importance of early screening and management of cardiovascular risk factors.

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Figures

Figure 1.
Figure 1.
Flow chart describing systematic search and study selection process
Figure 2.
Figure 2.
Forest plot for overall mortality in A) psoriatic arthritis B) ankylosing spondylitis
Figure 3.
Figure 3.
Forest plot for cause-specific mortality in psoriatic arthritis A) cardiovascular B) respiratory C) infections D) malignancy
Figure 4.
Figure 4.
Forest plot for cause-specific cardiovascular mortality in ankylosing spondylitis
See this image and copyright information in PMC

References

    1. Stolwijk C, Boonen A, van Tubergen A, Reveille JD. Epidemiology of spondyloarthritis. Rheum Dis Clin North Am. 2012;38(3):441–476. doi:10.1016/j.rdc.2012.09.003 - DOI - PMC - PubMed
    1. Yurkovich M, Vostretsova K, Chen W, Avina-Zubieta JA. Overall and cause-specific mortality in patients with systemic lupus erythematosus: a meta-analysis of observational studies. Arthritis Care Res (Hoboken). 2014;66:608–616. - PubMed
    1. Dadoun S, Zeboulon-Ktorza N, Combescure C, et al. Mortality in rheumatoid arthritis over the last fifty years: systematic review and meta-analysis. Joint Bone Spine. 2013;80:29–33. - PubMed
    1. Chou CH, Lin MC, Peng CL, Wu YC, Sung FC, Kao CH, et al. A nationwide population-based retrospective cohort study: increased risk of acute coronary syndrome in patients with ankylosing spondylitis. Scand J Rheumatol. 2014;43:132–6. - PubMed
    1. Karmacharya P, Ogdie A, Eder L. Psoriatic arthritis and the association with cardiometabolic disease: a narrative review. Ther Adv Musculoskelet Dis. 2021. Mar 2;13:1759720X21998279. doi: 10.1177/1759720X21998279. - DOI - PMC - PubMed

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