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- Published on: 25 January 2024
- Published on: 10 November 2023
- Published on: 25 January 2024Response to HLA-B27, axial spondyloarthritis and survival by Zhixiu Li et al.
The authors report that AS is associated with an increased mortality, more so among the females (1). Their observations further strengthen the recent understanding that women are not so lucky (2) after all, when they acquire AS. However, we would like to point out to a neglected point in the current report, an issue related to the proposed sex differences in the risk of death.
The mean age of entry of AS patients into this work was 44 years. On the other hand, we know that AS usually starts well before age 30 and according to one study, at a median age of 25 for males and 28 for females (3). Thus, most of the patients in the current report had AS years before entering this study. Therefore, the current report really concerns the fate of AS patients after quite a number of years of disease duration. A previous study about mortality in AS had shown that males and females had a similar survival after disease onset for about a decade after which the decrease in male survival became apparent. On the other hand, it took 35 years from disease onset when the female survival began to decrease (4). It follows that the design of the current work does not allow us to assess the survival of AS from the time of disease onset.
Finally, we surely agree with the authors that more work is needed to assess the proposed increased mortality among women with AS.Conflict of Interest:
None declared. - Published on: 10 November 2023Correspondence on 'HLA-B27, Axial Spondyloarthritis, and Survival'
We were intrigued by the recently published paper in the Annals of Rheumatic Diseases titled "HLA-B27, Axial Spondyloarthritis, and Survival" by Li et al.[1] This study explores the association between HLA-B27 carriage, axial spondyloarthritis (axSpA), and survival, offering valuable insights. By combining data from a 35-year follow-up study of Ankylosing Spondylitis (AS) and axSpA patients with the extensive UK Biobank dataset, the study significantly enhances our understanding of mortality patterns in AS/axSpA and the potential impact of HLA-B27 in the general population. We consider this study's implications important and look forward to critically examining its key findings and broader implications. However, there are some concerns that would better be clarified.
First and foremost, the observed gender-based differences in AS mortality are intriguing, with women generally exhibiting less severe sacroiliac joint damage.[2] However, an important consideration is the potential influence of HPV infection.[3] Surprisingly, the original study did not account for this factor, despite previous research linking HPV infection to autoimmune diseases, including AS, and suggesting a significantly elevated risk for AS development in HPV-infected individuals.[4] These findings underscore the complex interplay between infectious agents and autoimmune conditions. Additionally, prior research has indicated higher mortality in HPV-infected patients, emphasizing the...
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None declared.