Spondyloarthritis and the Heart: From Pathogenesis to Clinical Management

Abstract

Spondylarthritis (SpA), especially ankylosing spondylitis (AS), is linked to a significantly higher risk of cardiovascular disease and death. This review summarizes current understanding of the complex connection between SpA and heart health. Chronic systemic inflammation, a key feature of SpA, promotes cardiovascular problems through shared mechanisms involving atherosclerosis, endothelial dysfunction, and immune-mediated vascular damage. Major heart issues include cardiomyopathy, conduction abnormalities, aortitis, and valvular diseases, which are more common in male patients with long-term disease (>15 years). Immunopathogenesis plays a crucial role in involving immune cells (e.g., macrophages, T lymphocytes) and inflammatory mediators, leading to both joint and vascular problems. Extracellular vesicles and microRNAs are emerging as new factors involved in vascular comorbidity. While traditional cardiovascular risk factors are relevant, the ongoing inflammatory burden is a crucial independent trigger. Active management of cardiovascular risk, including careful monitoring and control of inflammation (possibly through biologic therapies such as TNFα antagonists), is essential. However, more research is needed to determine whether specific anti-inflammatory treatments can improve long-term cardiovascular outcomes. Customized screening approaches and integrated management are vital for reducing cardiovascular risk in patients with SpA.