The Risk of Cardiovascular Diseases in Axial Spondyloarthritis. Current Insights

Area of Science:

• Rheumatology
• Cardiology
• Immunology

Background:

• Axial spondyloarthritis (axSpA) is associated with significantly increased cardiovascular (CV) risk, leading to higher CV mortality and morbidity.
• This elevated risk is attributed to a combination of traditional CV risk factors, chronic inflammation, and potentially non-steroidal anti-inflammatory drug (NSAID) use.

Purpose of the Study:

• To explore the multifaceted factors contributing to enhanced CV risk in axSpA patients.
• To discuss the role of various treatments, including NSAIDs and biologics, in modulating CV risk within this population.
• To highlight the importance of early CV risk detection and management in axSpA according to current recommendations.

Main Methods:

• Review of existing literature on cardiovascular comorbidity in axial spondyloarthritis.
• Analysis of the impact of inflammatory processes and pharmacological treatments (NSAIDs, TNF inhibitors, IL-17 inhibitors) on CV risk.
• Emphasis on non-invasive techniques for early detection of CV involvement.

Main Results:

• NSAIDs may have a detrimental effect on CV risk in axSpA, while TNF inhibitors show potential benefits, requiring further clinical validation.
• Limited data exist on CV comorbidity in non-radiographic axSpA compared to the radiographic form.
• Early, pre-clinical CV involvement in axSpA is detectable through non-invasive methods.

Conclusions:

• Current axSpA management, guided by EULAR recommendations, must integrate CV risk assessment and management.
• Rheumatologists are pivotal in identifying and managing CV risk, focusing on disease activity control, inflammation suppression, and managing traditional CV risk factors.
• Further research is needed to clarify the CV effects of IL-17 inhibitors and to gather more data on non-radiographic axSpA patients.