Trip Answers

Question answered:25/08/06 Warning! this question is over two years old.

We searched initially for evidence about ankylosing spondylitis (AS), then more broadly at connective tissue diseases. Regarding AS, GP Notebook says (1):

 

“The extra-skeletal manifestations of ankylosing spondylitis are:
cardiac complications: 

 - aortic valve disease usually causing aortic regurgitation
 - conduction defects
 - carditis”

 

PRODIGY on AS says (2):

 

“Cardiac complications include conduction defects and aortic valve problems, and occur rarely. They are normally complications of late disease.”

 

We found no further substantial evidence (for example, RCTs or a systematic review) using Cochrane and Medline. Links to examples of 3 primary studies are provided below (3, 4, 5), two of which suggested a limited effect when studied in men.

 

In broader terms looking at connective tissue diseases, again we found no substantial evidence. We found two reviews on Medline, links for which are provided below. The first (6) suggests an increased risk for spondyarthropathies but that this may be due to conventional factors such as smoking, lipids, hypertension and decreased physical activity. The second suggests (7):

 

“The connective tissue diseases can provoke inflammation and fibrosis in any of the diverse cardiac structures, with the consequent complications. These alterations are frequent, with a high degree of morbidity, and have a direct relationship with the severity and chronicity of the primary connective tissue disease. Some of these patients respond favorably to cardiological and anti-inflammatory management, while others are refractory to such treatments.”

 

However, it isn’t clear how this applies directly to the subgroups of patients considered (who had ‘rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, progressive systemic sclerosis, dermatomyositis-polymyositis and mixed connective tissue disease’).

 

We were unable to find evidence that looked at connective tissue diseases in relation to current risk assessment charts. In terms of assessment of cardiovascular risk, the Joint British Societies' (JSB2) “guidelines on prevention of cardiovascular disease in clinical practice” (8) make it clear that the charts do not directly apply to patients with exiting morbidity which renders them at higher risk:

 

“The use of these charts is not appropriate for people who have existing atherosclerotic disease or are at higher risk for other medical reasons.”

 

References

1.  GP Notebook. “AS: extra-skeletal manifestations.”
(http://www.gpnotebook.co.uk/simplepage.cfm?ID=1825570840&linkID=43587&cook=yes)
2.  PRODIGY. “AS.” Last revised July 05.
(http://www.prodigy.nhs.uk/ankylosing_spondylitis/view_whole_guidance)
3.  Brunner, F. et al. “Ankylosing spondylitis and heart abnormalities: do cardiac conduction disorders, valve regurgitation and diastolic dysfunction occur more often in male patients with diagnosed ankylosing spondylitis for over 15 years than in the normal population?” Clinical rheumatology, Feb 06, 25 (1), pgs 24 – 29.
(http://www.hubmed.org/display.cgi?uids=16247583)
4.  Divecha, H. et al. “Cardiovascular risk parameters in men with ankylosing spondylitis in comparison with non-inflammatory control subjects: relevance of systemic inflammation.” Clinical science, Aug 05, 109 (2), pgs 171 – 176.
(http://www.hubmed.org/display.cgi?uids=15801904)
5.  Alves, M. G. et al. “Cardiac alterations in ankylosing spondylitis.” Angiology, July 88, 39 (7 pt 1) pgs 567 – 571.
(http://www.hubmed.org/display.cgi?uids=3408021)
6.  Peters, M. J. et al. “Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis.” Seminars in arthritis and rheumatism, Dec 04, 34 (3), pgs 585 – 592.
(http://www.hubmed.org/display.cgi?uids=15609262)
7.  Badui – Dergal, E. “The heart in various connective tissue diseases.” Gaceta médica de México, May - June 90, 126 (3), pgs 175 – 187.
(http://www.hubmed.org/display.cgi?uids=2094619)
8. JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice.” Heart, 05, 91 (suppl_5), v1-v52.
(http://heart.bmjjournals.com/cgi/reprint/91/suppl_5/v1?ijkey=PbMmm2L5wGIMU&keytype=ref&siteid=bmjjournals

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