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Risk of cardiac rhythm disturbances and aortic regurgitation in different spondyloarthritis subtypes in comparison with general population: a register-based study from Sweden
  1. Karin Bengtsson1,
  2. Helena Forsblad-d’Elia1,2,
  3. Elisabeth Lie1,3,
  4. Eva Klingberg1,
  5. Mats Dehlin1,
  6. Sofia Exarchou4,
  7. Ulf Lindström1,
  8. Johan Askling5,
  9. Lennart T H Jacobsson1
  1. 1Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
  2. 2Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
  3. 3Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  4. 4Department of Clinical Sciences, Section of Rheumatology, Lund University, Malmö, Sweden
  5. 5Department of Medicine Solna, Clinical Epidemiology Unit and Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Karin Bengtsson, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg S-405 30, Sweden;{at}


Objectives To describe the incidence of atrioventricular (AV) block II–III, atrial fibrillation (AF), pacemaker implantation (PM) and aortic regurgitation in patients with ankylosing spondylitis (AS), undifferentiated spondyloarthritis (uSpA) and psoriatic arthritis (PsA) compared with the general population (GP) and with each other.

Methods A prospective nationwide study with cohorts of patients with AS (n=6448), PsA (n=16 063) and uSpA (n=5190) and a GP (n=2 66 435) cohort, identified in 2001–2009 in the Swedish National Patient and Population registers. Follow-up began on 1 January 2006 and ended at event, death, emigration or 31 December 2012. Age-standardised and sex-standardised incidence rates and hazard ratios (HRs) were calculated.

Results The highest incidence rates were noted for AF (5.5–7.4 events per 1000 person-years), followed by PM (1.0–2.0 events per 1000 person-years). HRs for AV block, AF, PM and aortic regurgitation were significantly increased in AS (HRs 2.3, 1.3, 2.1 and 1.9), uSpA (HRs 2.9, 1.3, 1.9 and 2.0) and PsA (HRs 1.5, 1.5, 1.6 and 1.8) compared with the GP cohort. The highest HRs were seen for AV block in male uSpA (HR 4.2) and AS (HR 2.5) compared with GP. Compared with PsA, significantly increased HRs were noted for PM (HR 1.5) in AS and for AV block (HR 1.8) in uSpA.

Conclusions Patients with SpA are at increased risk of aortic regurgitation, cardiac rhythm disturbances and, as a probable consequence, also PM. Particularly for AF, the most common arrhythmia, increased caution is warranted, whereas AV block should be looked for especially in men with AS or uSpA.

  • ankylosing spondylitis
  • psoriatic arthritis
  • spondyloarthritis
  • cardiovascular disease

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  • Handling editor Hans WJ Bijlsma

  • Contributors KB contributed to the design of the study, data acquisition, analysis and interpretation of data and drafting the manuscript. HF-dE contributed to the interpretation of data and drafting the manuscript. EL, EK, MD, SE and UL contributed to the interpretation of data and have revised the manuscript critically for important intellectual content. JA contributed to the design of the study, interpretation of data and has revised the manuscript critically for important intellectual content. LTHJ contributed to the design of the study, interpretation of data and drafting the manuscript. All authors have read and approved the final manuscript.

  • Funding This work was supported by grants from the University of Gothenburg, the Region Västra Götaland, Sahlgrenska University Hospital (agreement concerning research and educations of doctors), Stockholm County Council (ALF), the Medical Society of Gothenburg, Göteborg’s Association Against Rheumatism, Swedish Rheumatism Association, the Swedish Research Council, the Swedish Heart-Lung Foundation and the Swedish Foundation for Strategic research.

  • Competing interests HF-dE has received advisory board fees from Sandoz and Novartis and unrestricted grant from Novartis. EL has received consultancy and/or speaker honoraria from Abbvie, Celgene, Pfizer and UCB. JA has received research grants from Abbvie, AstraZeneca, Merck, Pfizer, Roche, Samsung and UCB in relation to work based on the Swedish Biologics Register ARTIS. JA reported participating in research projects fully or partly funded by Novo Nordisk. LJ has received advisory board fees from Abbvie, Pfizer and Novartis. All other authors declare that they have no competing interests.

  • Ethics approval Regional Ethics Committee, Stockholm, Sweden.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data sets generated and/or analysed during the present study are not publicly available due to the Swedish legislation (the Personal Data Act). The authors have access to raw data for the present study and may be contacted for inquiries.

  • Author note Some of the preliminary results have been presented as an oral abstract at American Congress of Rheumatology 2015 and as abstract/poster at the Swedish Rheumatology Meeting 2016.40 41