Article Text

Extended report
Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis
  1. Carmen Stolwijk1,2,
  2. Astrid van Tubergen1,2,
  3. José Dionisio Castillo-Ortiz3,
  4. Annelies Boonen1,2
  1. 1Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
  2. 2School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, The Netherlands
  3. 3Unidad de Investigacion em Enfermadades Cronico-Degenerativas, Hospital General de Zona 50, Guadalajara, Mexico
  1. Correspondence to Dr Carmen Stolwijk, Department of Medicine, Division of Rheumatology, Maastricht University Medical Center; School for Public Health and Primary Care (CAPHRI), University of Maastricht, PO Box 5800, Maastricht 6202 AZ, The Netherlands; c.stolwijk{at}


Objectives Uveitis, psoriasis and inflammatory bowel disease (IBD) are common extra-articular manifestations (EAM) in patients with ankylosing spondylitis (AS); however, summary data of reported prevalence are lacking. The aim of the present study was to summarise the prevalence of EAMs among patients with AS and to identify underlying factors to explain potential heterogeneity of prevalence.

Methods A systematic literature search was performed (Medline, Embase and Cochrane Library) to identify relevant articles. Risk of bias was assessed and data were extracted. Pooled prevalences were calculated. Potential sources of any observed clinical or methodological heterogeneity in the estimates were explored by subgroup and metaregression analysis.

Results In the 156 selected articles, 143 reported the prevalence of uveitis (44 372 patients), 56 of psoriasis (27 626 patients) and 69 of IBD (30 410 patients). Substantial heterogeneity was observed in prevalence estimates among all EAMs (I2=84–95%). The pooled prevalence of uveitis was 25.8% (95% CI 24.1% to 27.6%), and was positively associated in multivariable metaregression with disease duration (β 0.05, 95% CI 0.03 to 0.08) and random selection of patients (β −0.24, 95% CI −0.43 to −0.04). The pooled prevalence of psoriasis was 9.3% (95% CI 8.1% to 10.6%). The pooled prevalence of IBD was 6.8% (95% CI 6.1% to 7.7%) and was positively associated with the percentage of women in the studies (β 0.02, 95% CI 0.00 to 0.03). Geographical area was associated in multivariable metaregressions with prevalence of all EAMs.

Conclusions EAMs are common in patients with AS. The large heterogeneity between studies can be partly explained by differences in clinical as well as methodological characteristics.

  • Ankylosing Spondylitis
  • Epidemiology
  • Spondyloarthritis
View Full Text

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.