The epidemiology of extra-articular manifestations in ankylosing spondylitis: a population-based matched cohort study

Annals of the Rheumatic Diseases - Tập 74 Số 7 - Trang 1373-1378 - 2015
C. Stolwijk1, I. Essers1, Astrid van Tubergen2, Annelies Boonen2, Marloes T Bazelier3, Marie L. De Bruin3, Yolanda van der Graaf4
1Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands Division of Rheumatology, Department of Medicine, Maastricht University Medical Center, Maastricht, The Netherlands Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
2Division of Rheumatology, Department of Medicine, Maastricht University Medical Center, Maastricht, The Netherlands Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
3Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
4Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK.

Tóm tắt

ObjectiveTo assess the incidence and risks of common extra-articular manifestations (EAMs), that is, acute anterior uveitis (AAU), psoriasis and inflammatory bowel disease (IBD), in patients with ankylosing spondylitis (AS) compared with population-based controls.MethodsAll incident patients with AS (n=4101) from the UK Clinical Practice Research Datalink (1987–2012) were matched with up to seven control subjects without AS by year of birth, sex and practice (n=28 591). Incidence rates, cumulative incidence rates and adjusted (adj) HRs for the development of EAMs were calculated, with time-dependent adjustments for age, sex, comorbidity and medication use.ResultsAt diagnosis of AS, the proportion of patients with an EAM was 11.4% for AAU, 4.4% for psoriasis and 3.7% for IBD. Incidence rates of EAMs were 8.9/1000 person-years for AAU, 3.4/1000 person-years for psoriasis and 2.4 /1000 person-years for IBD in AS. The 20-year cumulative incidence was 24.5%, 10.1% and 7.5%, respectively. Risks of EAMs were 1.5-fold to 16-fold increased versus controls, with an adj HR of 15.5 (95% CI 11.6 to 20.7) for AAU, adj HR of 1.5 (95% CI 1.1 to 1.9) for psoriasis and adj HR of 3.3 (95% CI 2.3 to 4.8) for IBD. For psoriasis and IBD, the highest risks were found in the 1st years after diagnosis, while developing AAU continued to be increased also 10 years after diagnosis of AS.ConclusionsThe risk of, in particular AAU, but also of psoriasis and IBD, is significantly increased in patients with AS compared with controls. Hazard patterns are different for each of the EAMs.

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Tài liệu tham khảo

Geirsson, 2010, Prevalence and clinical characteristics of ankylosing spondylitis in Iceland—a nationwide study, Clin Exp Rheumatol, 28, 333

Hanova, 2010, Incidence and prevalence of psoriatic arthritis, ankylosing spondylitis, and reactive arthritis in the first descriptive population-based study in the Czech Republic, Scand J Rheumatol, 39, 310, 10.3109/03009740903544212

Kaipiainen-Seppanen, 1997, Incidence and prevalence of ankylosing spondylitis in Finland, J Rheumatol, 24, 496

Braun, 1998, Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors, Arthritis Rheum, 41, 58, 10.1002/1529-0131(199801)41:1<58::AID-ART8>3.0.CO;2-G

Braun, 2007, Ankylosing spondylitis, Lancet, 369, 1379, 10.1016/S0140-6736(07)60635-7

Moll JM, Haslock I, Macrae IF, et al. Associations between ankylosing spondylitis, psoriatic arthritis, Reiter's disease, the intestinal arthropathies, and Behcet's syndrome. Medicine (Baltimore). 1974/09/01 ed1974. p. 343–64.

El Maghraoui, 2011, Extra-articular manifestations of ankylosing spondylitis: prevalence, characteristics and therapeutic implications, Eur J Intern Med, 22, 554, 10.1016/j.ejim.2011.06.006

Rudwaleit, 2004, How to diagnose axial spondyloarthritis early, Ann Rheum Dis, 63, 535, 10.1136/ard.2003.011247

Molto, 2013, Performances of the Assessment of SpondyloArthritis International Society Axial Spondyloarthritis criteria for diagnostic and classification purposes in patients visiting a rheumatologist because of chronic back pain: results from a multicenter, crosssectional study, Arthritis Care Res (Hoboken), 65, 1472, 10.1002/acr.22016

Amor, 1990, [Criteria of the classification of spondylarthropathies], Rev Rhum Mal Osteoartic, 57, 85

Dougados, 1991, The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy, Arthritis Rheum, 34, 1218, 10.1002/art.1780341003

Rudwaleit, 2009, The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection, Ann Rheum Dis, 68, 777, 10.1136/ard.2009.108233

Rudwaleit, 2011, The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general, Ann Rheum Dis, 70, 25, 10.1136/ard.2010.133645

Braun, 2011, 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis, Ann Rheum Dis, 70, 896, 10.1136/ard.2011.151027

Stolwijk, 2015, Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis, Ann Rheum Dis, 74, 65, 10.1136/annrheumdis-2013-203582

Zeboulon, 2008, Prevalence and characteristics of uveitis in the spondyloarthropathies: a systematic literature review, Ann Rheum Dis, 67, 955, 10.1136/ard.2007.075754

Bremander, 2011, Population-based estimates of common comorbidities and cardiovascular disease in ankylosing spondylitis, Arthritis Care Res (Hoboken), 63, 550, 10.1002/acr.20408

Khan, 2010, Validity of diagnostic coding within the General Practice Research Database: a systematic review, Br J Gen Pract, 60, e128, 10.3399/bjgp10X483562

Feldtkeller, 2003, Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis, Rheumatol Int, 23, 61, 10.1007/s00296-002-0237-4

Gritz, 2004, Incidence and prevalence of uveitis in Northern California; the Northern California Epidemiology of Uveitis Study, Ophthalmology, 111, 491, 10.1016/j.ophtha.2003.06.014

Paivonsalo-Hietanen, 1997, Incidence and prevalence of different uveitis entities in Finland, Acta Ophthalmol Scand, 75, 76, 10.1111/j.1600-0420.1997.tb00255.x

Loftus, 2004, Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences, Gastroenterology, 126, 1504, 10.1053/j.gastro.2004.01.063

Parisi, 2013, Global epidemiology of psoriasis: a systematic review of incidence and prevalence, J Invest Dermatol, 133, 377, 10.1038/jid.2012.339

Rudwaleit, 2009, The early disease stage in axial spondylarthritis: results from the German Spondyloarthritis Inception Cohort, Arthritis Rheum, 60, 717, 10.1002/art.24483

Dougados, 2011, The DESIR cohort: a 10-year follow-up of early inflammatory back pain in France: study design and baseline characteristics of the 708 recruited patients, Joint Bone Spine, 78, 598, 10.1016/j.jbspin.2011.01.013

Brophy, 2012, No increased rate of acute myocardial infarction or stroke among patients with ankylosing spondylitis-a retrospective cohort study using routine data, Semin Arthritis Rheum, 42, 140, 10.1016/j.semarthrit.2012.02.008

Lewis, 2002, Validity and completeness of the General Practice Research Database for studies of inflammatory bowel disease, Pharmacoepidemiol Drug Saf, 11, 211, 10.1002/pds.698

Braun, 2005, Decreased incidence of anterior uveitis in patients with ankylosing spondylitis treated with the anti-tumor necrosis factor agents infliximab and etanercept, Arthritis Rheum, 52, 2447, 10.1002/art.21197

Braun, 2007, Differences in the incidence of flares or new onset of inflammatory bowel diseases in patients with ankylosing spondylitis exposed to therapy with anti-tumor necrosis factor alpha agents, Arthritis Rheum, 57, 639, 10.1002/art.22669

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Thông tin xuất bản

Annals of the Rheumatic Diseases

Tập 74 Số 7

1373-1378

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