Recent Advancements in Ankylosing Spondylitis and Its Connection to Valvular Heart Diseases
Main Article Content
Abstract
Background: Ankylosing spondylitis (AS) is a chronic, systemic, immune-mediated inflammatory disease primarily affecting the axial skeleton and is increasingly recognized for its cardiovascular manifestations, notably valvular heart diseases (VHD), particularly aortic and mitral insufficiencies.
Objectives: To explore the pathophysiological, clinical, and diagnostic relationships between AS and VHD, highlight recent advancements in diagnostic tools and therapeutic interventions, and discuss strategies for multidisciplinary management.
Methods: This narrative review synthesizes findings from clinical studies, histopathological evidence, and imaging reports. It discusses immune-mediated mechanisms, diagnostic challenges in kyphotic patients, and outcomes from emerging therapies including IL-17 and TNF-α inhibitors.
Results: AS is associated with structural and functional cardiac alterations such as aortic root dilatation, valvular fibrosis, and regurgitation. Echocardiography and cardiac MRI are essential for early diagnosis. Clinical studies show that AS-related VHD leads to increased morbidity and mortality. New biologics have shown promising effects in reducing systemic inflammation and potentially mitigating cardiac complications.
Conclusions: A multidisciplinary approach involving rheumatology, cardiology, and imaging experts is essential for managing patients with AS and VHD. Future research should focus on predictive biomarkers, longitudinal studies, and personalized treatment strategies. Early detection and intervention may significantly improve clinical outcomes and quality of life.
Article Details
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References
2. Wei Zhu, Xuxia He, Xisheng Weng et al. Ankylosing spondylitis: etiology, pathogenesis, and treatment. Bone Res. 2019 Aug 5; 7:22. doi: 10.1038/ s41413-019-0057-8
3. Parv Agrawal, Sachin Tote, Bhagyesh Sapkale. Diagnosis and Treatment of Ankylosing Spondylitis. Cureus. 2024 Jan 19;16(1): e52559. doi: 10.7759/ cureus.52559.
4. Alireza Rezaiemanesh, Mohammad Hossein Nicknam et al. Immune cells involved in the pathogenesis of ankylosing spondylitis, 2018 Apr:100:198-204. doi: 10.1016/j.biopha.2018.01.1 08. Epub 2018 Feb 16.
5. Balázs Szalay, Attila Balog et al. Adaptive Immunity in Ankylosing Spondylitis: Phenotype and Functional Alterations of T-Cells before and during Infliximab Therapy. Clin Dev Immunol. 2011 Sep 28; 2012:808724. doi: 10.1155/ 2012/808724
6. Cailin H Sibley, Autoinflammation and HLA-B27: More than an Antigen. Ocul Immunol Inflamm. 2016 May 26;24(4):460–469. doi: 10.1080/092739 48.2016.1175641
7. Sai Harika Pujari; Pradyumna Agasthi. Aortic Stenosis. Treasure Island (FL): StatPearls Publishing; 2025 Jan.
8. Saikrishna Patibandla; Joseph Heaton; Joseph S. Azzam, Aortic Insufficiency, Treasure Island (FL). StatPearls Publishing; 2025 Jan.
9. Robert O. Jack S. Shanewise et al, 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients with Valvular Heart Disease. Circulation, Volume 118, Number 15, doi.org/10.1161/ CIRCULATION AHA.108.190748.
10. H Boudoulas, M Vavuranakis, C F Wooley. Valvular heart disease: the influence of changing etiology on nosology. J Heart Valve Dis. 1994 Sep;3(5):516-26.
11. Samantha S R Crossfield, Philip G Conaghan et al. Changes in ankylosing spondylitis incidence, prevalence and time to diagnosis over two decades. RMD Open. 2021 Dec;7(3): e001888. doi: 10.1136/r mdopen-2021-001888.
12. Nazanin Ebrahimiadib, Fatemeh Golsoorat Pahlaviani et al. Ankylosing Spondylitis, J Ophthalmic Vis Res. 2021 Jul 29;16(3):462–469. doi: 10.18502/jo vr.v16i3.9440.
13. Mina Tanios, Hossein Elgafy et al. Spondyloarthropathies That Mimic Ankylosing Spondylitis: A Narrative Review. Clin Med Insights Arthritis Musculoskelet Disord. 2023 Jul 25; 16:117 95441231186822. doi: 10.1177/11795441231186822
14. Nadira Hamid, Daniel Burkhoff et al, Transcatheter Left Ventricular Restoration in Patients with Heart Failure. J Card Fail. 2023 Jul;29(7):1046-1055. doi: 10.1016 /j. cardfail.2023.03.003. Epub 2023 Mar 22.
15. Siwar Eid, Abdulla Watad et al. Ankylosing spondylitis is associated with increased prevalence of valvular heart diseases: a cross-sectional population-based study. Postgrad Med J. 2023 Sep 21;99(1176):1088-1093. doi: 10.1093/postmj/qga d045.
16. Nisha Nigil Haroon et al. Patients with Ankylosing Spondylitis Have Increased Cardiovascular and Cerebrovascular Mortality: A Population-Based Study. Ann Intern Med. 2015 Sep 15;163(6):409-16. doi: 10.7326/M14-2470.
17. Wun-Zhih Siao, Gwo-Ping Jong et al, Increased risk of valvular heart disease in patients with ankylosing spondylitis: a nationwide population-based longitudinal cohort study. Ther Adv Musculoskelet Dis. 2021 Jun 18; 13:1759720X211 021676. doi: 10.1177/1759720X211021676
18. Bin Chen, Weidong Xu et al. Role of HLA-B27 in the pathogenesis of ankylosing spondylitis. Mol Med Rep. 2017 Feb 24;15(4):1943–1951. doi: 10.3892/mmr .2017.6248
19. Michael Simons, Stefanie Dimmeler et al. State-of-the-Art Methods for Evaluation of Angiogenesis and Tissue Vascularization: A Scientific Statement From the AHA, Circ Res. 2015 Apr 30; 116(11): e99–132. doi: 10.1161/RES.00000000000 00054.
20. Annual European Congress of Rheumatology, annals of rheumatic disease, 6 – 9 June, 2022, Berlin, Germany.
21. Grant H Louie, Michael M Ward. Measurement and treatment of radiographic progression in ankylosing spondylitis: lessons learned from observational studies and clinical trials. Curr Opin Rheumatol. 2014 Mar;26(2):145-50. doi: 10.1097/BOR.0000000000000025.
22. Catherine M. Otto, Rick A. Nishimura, and Christopher Toly et al. 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, Volume 143, Number 5, doi.org/10.1161/CIR.0000 000000000923.
23. Sana M. Al-Khatib, William G. Stevenson, and Richard L. Page et al, 2017 AHA/ACC/HRS Guideline for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation, Volume 138, Number, doi.org/10.1161/CIR.0000000000000549.
24. Holly C Gooding, Bonnie Spring et al, Challenges and Opportunities for the Prevention and Treatment of Cardiovascular Disease Among Young Adults: Report From a National Heart, Lung, and Blood Institute Working Group. J Am Heart Assoc. 2020 Sep 30;9(19):e016115. doi: 10.1161/J AHA.120.016115
25. Pradnya Brijmohan Bhattad, Mazen Roumia et al. Cardiovascular Morbidity in Ankylosing Spondylitis: A Focus on Inflammatory Cardiac Disease. Cureus. 2022 Jun 3;14(6): e25633. doi: 10.7759/cur eus.25633.
26. David P Baker, Paul Barach et al. The role of teamwork in the professional education of physicians: current status and assessment recommendations, Jt Comm J Qual Patient Saf. 2005 Apr;31(4):185-202. doi: 10.1016/s1553-7250(05)31025-7.
27. Jan Lin, Ram Raj Singh et al. TNFα blockade in human diseases: An overview of efficacy and safety, Clin Immunol. 2007 Oct 4;126(1):13–30. doi: 10.1016 /j. clim.2007.08.012