Mortality incidence in spondyloarthritis: real-world evidence using the TriNetX Global Collaborative Network

To assess all-cause mortality in patients with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), and to examine the influence of sex, comorbidities and biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in a large, multinational, real-world cohort.

This retrospective cohort study used the TriNetX Global Collaborative Network, comprising anonymised electronic health records from over 150 million individuals across >100 healthcare organisations worldwide. Adults with ≥2 diagnoses of ankylosing spondylitis or arthropathic psoriasis between 2010 and 2020 were included. Propensity score matching accounted for demographics and comorbidities. Kaplan-Meier survival analysis and Cox proportional hazards models were used to estimate HRs for all-cause mortality, comparing axSpA and PsA cohorts with each other and with matched general population controls.

We identified 32 368 patients with axSpA, 52 402 patients with PsA and 9 742 949 controls. Compared with the general population, mortality risk was significantly higher in axSpA (HR 1.71, 95% CI 1.61 to 1.81) and PsA (HR 1.26, 95% CI 1.20 to 1.32). Mortality was 42% greater in axSpA than PsA (HR 1.42, 95% CI 1.34 to 1.51). Male sex was associated with increased mortality (axSpA HR 1.65; PsA HR 1.26). Treatment with b/tsDMARDs, particularly tumour necrosis factor (TNF) inhibitors, reduced mortality by 47% in axSpA and 38% in PsA compared with untreated patients.

All-cause mortality remains elevated in axSpA and PsA, particularly in axSpA. Male sex predicts poorer survival, whereas TNF inhibitor therapy is associated with improved outcomes. Early, targeted management may help reduce mortality in spondyloarthritis.