Impact of axial spondyloarthritis clinical features on cardiovascular risk

Axial spondyloarthritis (axSpA) is a group of inflammatory disorders characterized by the involvement of axial and peripheral joints, as well as systemic manifestations. Cardiovascular diseases (CVD) are a leading cause of mortality in patients with axSpA, and anti-inflammatory therapy with NSAIDs may further increase cardiovascular risk (CVR). While conventional CVR factors are well-established, a comprehensive CVR assessment in axSpA requires consideration of disease-specific features that complicate risk management. The COMOSPA study indicated that the association of SpA with psoriasis elevates CVR, particularly in cases with peripheral joint involvement. Regarding radiographic progression, a relationship was demonstrated between the mSASSS index and both arterial hypertension (AH) and CVR, whereas the BASRI was not associated with CVR. Studies on the impact of disease activity have shown that ineffective treatment and persistent inflammation are linked to increased AH and CVR. Conversely, NSAID therapy, by reducing disease activity and improving spinal mobility, was associated with lower CVR. Furthermore, a cohort of patients with "difficult-to-treat" axial spondyloarthritis demonstrated higher CVR, underscoring the importance of achieving remission or low disease activity for risk reduction. Persistent structural damage observed radiographically, in conjunction with elevated C-reactive protein and increased carotid intima-media thickness, was associated with higher CVR. Critically, studies have confirmed an increased incidence of major adverse cardiovascular events, such as acute coronary syndrome and stroke, in axSpA patients. In conclusion, current evidence confirms the necessity of achieving treatment targets through effective therapy to reduce mortality in patients with axSpA and comorbid cardiovascular pathology.

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