Axial Spondyloarthritis & Psoriatic Arthritis: Higher Mortality Risk, b/tsDMARDs Help

People living with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) may face a heightened risk of death compared to the general population, according to recent research. However, the study also indicates that treatment with biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) appears to mitigate this increased risk.

Understanding Axial Spondyloarthritis and Psoriatic Arthritis

Both axSpA and PsA are chronic inflammatory conditions. Axial spondyloarthritis primarily affects the spine, causing pain and stiffness. Psoriatic arthritis, as the name suggests, is linked to psoriasis, a skin condition, and causes joint pain, stiffness, and swelling. These conditions can significantly impact quality of life, and increasingly, research is focusing on their broader health implications beyond musculoskeletal symptoms.

The findings, initially reported by Medscape News UK, stem from a real-world study examining outcomes in a large cohort of patients. This type of research, observing patients in routine clinical practice, offers valuable insights that complement findings from more controlled clinical trials.

The Study: Design and Key Findings

The study, published in the journal Annals of the Rheumatic Diseases, analyzed data from the UK Biobank, a large-scale biomedical database and research resource. Researchers followed over 12,000 individuals with axSpA and over 8,000 with PsA, comparing their mortality rates to those of over 460,000 individuals in the general population. The study period spanned approximately 11 years.

The analysis revealed that individuals with axSpA had a 43% increased risk of all-cause mortality, while those with PsA had a 75% increased risk, compared to the general population. However, crucially, the researchers found that patients receiving b/tsDMARD treatment experienced a significantly reduced risk. Specifically, b/tsDMARD use was associated with a 28% reduction in mortality risk for axSpA patients and a 38% reduction for PsA patients.

What are b/tsDMARDs?

Biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) represent a newer generation of treatments for inflammatory arthritis. Unlike traditional DMARDs, which often work by broadly suppressing the immune system, b/tsDMARDs target specific parts of the immune pathway involved in inflammation. This more targeted approach can be highly effective in controlling disease activity and improving symptoms. Examples include TNF inhibitors, IL-17 inhibitors, and JAK inhibitors. Versus Arthritis provides a comprehensive overview of these medications.

Interpreting the Results: Correlation vs. Causation

It’s important to emphasize that this study demonstrates an association between axSpA/PsA, mortality risk, and treatment with b/tsDMARDs. It does not definitively prove that axSpA or PsA *cause* an increased risk of death, nor does it prove that b/tsDMARDs directly *reduce* mortality. Other factors, known as confounders, could be at play. For example, individuals with more severe disease or other underlying health conditions might be more likely to die, and these factors could also influence treatment decisions.

The researchers attempted to account for several potential confounders, including age, sex, socioeconomic status, smoking status, and the presence of other health conditions. However, it’s always possible that some unmeasured confounders could have influenced the results. The study relied on observational data, which is inherently susceptible to bias.

Who is Affected? Prevalence and Risk Factors

Axial spondyloarthritis affects an estimated 1.4% of the adult population, while psoriatic arthritis affects approximately 0.3% to 1% of the population. These conditions typically develop between the ages of 20 and 40, although they can occur at any age.

Several factors can increase the risk of developing axSpA or PsA, including genetics (having a family history of these conditions) and environmental factors. For those already diagnosed, factors that may contribute to a higher risk of mortality include disease severity, the presence of other health conditions (such as cardiovascular disease or diabetes), and inadequate disease control.

Beyond Mortality: The Impact of Chronic Inflammation

The increased mortality risk observed in this study highlights the systemic nature of axSpA and PsA. These conditions are not simply limited to joint pain and stiffness; chronic inflammation can have far-reaching effects on the body, increasing the risk of cardiovascular disease, infections, and other serious health problems.

Cardiovascular disease is a particularly significant concern for individuals with inflammatory arthritis. Inflammation can contribute to the development of atherosclerosis (plaque buildup in the arteries), increasing the risk of heart attack and stroke. Managing cardiovascular risk factors, such as high blood pressure and high cholesterol, is crucial for people with axSpA and PsA.

What Does This Mean for Patients?

These findings underscore the importance of early diagnosis and effective treatment for axSpA and PsA. Prompt initiation of b/tsDMARD therapy, when appropriate, may aid to reduce disease activity, improve symptoms, and potentially lower the risk of long-term complications, including mortality.

However, it’s crucial to remember that treatment decisions should be made on an individual basis, in consultation with a qualified rheumatologist. The benefits and risks of b/tsDMARD therapy should be carefully considered, taking into account the patient’s overall health status and preferences.

Public Health Implications and Future Research

The study’s findings have implications for public health surveillance and clinical practice guidelines. Increased awareness of the potential for increased mortality risk in individuals with axSpA and PsA may lead to more proactive monitoring and management of these conditions.

Further research is needed to confirm these findings in other populations and to better understand the mechanisms underlying the increased mortality risk. Studies are also needed to evaluate the long-term effects of b/tsDMARD therapy on mortality and other important outcomes. Ongoing clinical trials are exploring new and more effective treatments for axSpA and PsA, with the goal of improving the lives of people living with these conditions.

What comes next: Ongoing monitoring and guideline updates

Rheumatology societies and national health organizations routinely review emerging evidence, like this study, to update clinical practice guidelines. Expect to witness these findings incorporated into future recommendations regarding the management of axSpA and PsA, potentially emphasizing the importance of early and aggressive treatment with b/tsDMARDs for appropriate candidates. Continued surveillance of mortality rates in these patient populations will also be essential to track the impact of evolving treatment strategies.