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

Carmen Stolwijk; Ivette Essers; Astrid van Tubergen; Annelies Boonen; Marloes T Bazelier; Marie L De Bruin; Frank de Vries

doi:10.1136/annrheumdis-2014-205253

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

Carmen Stolwijk, Ivette Essers, Astrid van Tubergen, Annelies Boonen, Marloes T Bazelier, Marie L De Bruin, Frank de Vries

71 Citations (Scopus)

Abstract

OBJECTIVE: To 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.

METHODS: All 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.

RESULTS: At 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.

CONCLUSIONS: The 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.

Original language	English
Journal	Annals of the Rheumatic Diseases
Volume	74
Issue number	7
Pages (from-to)	1373-8
Number of pages	6
ISSN	0003-4967
DOIs	https://doi.org/10.1136/annrheumdis-2014-205253
Publication status	Published - 1 Jul 2015
Externally published	Yes

Keywords

Adolescent
Adult
Case-Control Studies
Female
Great Britain
Humans
Incidence
Inflammatory Bowel Diseases
Male
Middle Aged
Psoriasis
Retrospective Studies
Risk Factors
Spondylitis, Ankylosing
Uveitis, Anterior
Young Adult
Journal Article

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@article{9a893d4657c54315b2438dfd3626e62f,

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

abstract = "OBJECTIVE: To 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.METHODS: All 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.RESULTS: At 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.CONCLUSIONS: The 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.",

keywords = "Adolescent, Adult, Case-Control Studies, Female, Great Britain, Humans, Incidence, Inflammatory Bowel Diseases, Male, Middle Aged, Psoriasis, Retrospective Studies, Risk Factors, Spondylitis, Ankylosing, Uveitis, Anterior, Young Adult, Journal Article",

author = "Carmen Stolwijk and Ivette Essers and {van Tubergen}, Astrid and Annelies Boonen and Bazelier, {Marloes T} and {De Bruin}, {Marie L} and {de Vries}, Frank",

note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.",

year = "2015",

month = jul,

day = "1",

doi = "10.1136/annrheumdis-2014-205253",

language = "English",

volume = "74",

pages = "1373--8",

journal = "Annals of the Rheumatic Diseases",

issn = "0003-4967",

publisher = "B M J Group",

number = "7",

}

TY - JOUR

T1 - The epidemiology of extra-articular manifestations in ankylosing spondylitis

T2 - a population-based matched cohort study

AU - Stolwijk, Carmen

AU - Essers, Ivette

AU - van Tubergen, Astrid

AU - Boonen, Annelies

AU - Bazelier, Marloes T

AU - De Bruin, Marie L

AU - de Vries, Frank

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - OBJECTIVE: To 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.METHODS: All 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.RESULTS: At 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.CONCLUSIONS: The 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.

AB - OBJECTIVE: To 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.METHODS: All 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.RESULTS: At 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.CONCLUSIONS: The 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.

KW - Adolescent

KW - Adult

KW - Case-Control Studies

KW - Female

KW - Great Britain

KW - Humans

KW - Incidence

KW - Inflammatory Bowel Diseases

KW - Male

KW - Middle Aged

KW - Psoriasis

KW - Retrospective Studies

KW - Risk Factors

KW - Spondylitis, Ankylosing

KW - Uveitis, Anterior

KW - Young Adult

KW - Journal Article

U2 - 10.1136/annrheumdis-2014-205253

DO - 10.1136/annrheumdis-2014-205253

M3 - Journal article

C2 - 24658834

SN - 0003-4967

VL - 74

SP - 1373

EP - 1378

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

IS - 7

ER -

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

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Keywords

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