Cardiac complications in AS

The HLA-B27-related spondyloarthopathies are associated with cardiovascular disease in 2% to 10% of cases. Cardiovascular mortality is increased in patients with ankylosing spondylitis. A possible explanation might be a more prevalent atherogenic lipid profile in patients with ankylosing spondylitis than in the general population. It has been postulated that inflammation deteriorates the lipid profile, thereby increasing cardiovascular risk. An increase in disease activity has been associated with decreases in lipid levels. Inflammation and sclerosis of the aortic root and ventricular septum have been linked to the development of isolated aortic regurgitation and conduction abnormalities. It is suggested that clinicians consider the possibility of HLA-B27-associated cardiovascular disease in patients who have aortic and coronary aneurysms.

A recent review of data from patients enrolled an "integrated outcomes database" have shown that "cardiovascular diseases and their risk factors were more common in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis," than in those without these diseases.

A small number of people with spondylitis will display signs of chronic inflammation in the base of the heart - around the aortic valve and origin of the aorta (i.e. that vessel which takes all blood from the heart to be distributed throughout the body). Years of chronic and silent inflammation at these sites can eventually lead to heart block and valve leakage, sometimes requiring surgical treatment. Although recognized, these cardiac lesions probably are seen in fewer than two percent of all patients with spondylitis, and nearly always in males. The lesions are readily detectable by the physician's examination and when necessary, cardiac testing.

Also, adults with spondylitis often have chest pain that mimics the heavy chest pain of cardiac angina or pleurisy (the pain with deep breathing that occurs when the outer lining of the lung is inflamed). Anyone experiencing symptoms should seek medical attention to rule out a more serious condition. What often happens, over time, is that the joints between the ribs and spine, and where the ribs meet the breastbone in front of the chest, develop decreased chest expansion because of long-term inflammation and scarring of the tissues. If the pain is found to be spondylitis-related, it is important to practice critical deep breathing exercises to help maintain chest expansion.

References:

Chenglong Han et al. (2006, Sept 15). Cardiovascular Disease and Risk Factors in Patients with Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis. J Rheumatol 2006;33:2167-72

Norton, H. (2006, January / February ) The Heart in Spondylitis. Spondylitis Plus