Individual research recommendation details

Recommendation ID

NG65/2

Question

Long-term complications of spondyloarthritis:- What is the incidence of long-term complications, in particular osteoporosis, cardiovascular disease (CVD) and metabolic syndrome, in people with spondyloarthritis, and how does this compare with the general population? Are any specific spondyloarthritis features or risk factors associated with the incidence and outcomes of these complications?

Any explanatory notes
(if applicable)

Why this is important:- Spondyloarthritides are a group of systemic inflammatory conditions, and as such it is thought that people with these conditions may have an elevated risk of CVD, particularly if their disease is not adequately controlled. This may have direct vascular effects as well as precluding maintenance of a good level of cardiovascular fitness.
There is also clinical uncertainty around the long-term use of non-steroidal anti-inflammatory drugs (NSAIDs): whether the long-term CVD risks associated with this class of drugs are observed in this population, or whether the suppression of inflammation with these drugs mitigates some of the CVD risks associated with these conditions. In addition, risks of osteoporosis and fracture are known to be higher in people with axial spondyloarthritis than the general population, and the prevalence of axial manifestations in people diagnosed with peripheral disease implies the risks may also be high in peripheral spondyloarthritis.
The longer-term complication rates in the spondyloarthritides need to be established, as well as whether standard biological disease-modifying anti-rheumatic drug (DMARD) therapies and biological DMARDs influence these outcomes. Research that evaluates incidence of osteoporosis, CVD and metabolic syndrome in people with either axial or peripheral spondyloarthritis compared with the general population would therefore be of value. This research should take into account disease stage, personal activity levels and medicine use, and look to address how frequently it is appropriate to monitor people with spondyloarthritis for long-term complications.

Source guidance details

Comes from guidance

Spondyloarthritis in over 16s: diagnosis and management

Number

NG65

Date issued

February 2017

Other details