Prognosis
Patients who do well are those who lead active lifestyles and maintain a disciplined exercise programme. However, these patients may also have less severe disease, enabling them to be more vigilant in their exercise regimens.
The early course of juvenile spondyloarthropathy is mild and limited to peripheral arthritis and enthesitis. The number of sites with enthesitis may increase with time.
Progression of AS is highly variable. Increased disease severity may impact upon capacity to work; psychological and sociodemographical factors may also contribute.[227][228] Disease progression may ultimately lead to the fusion of the sacroiliac joints and the vertebral column, resulting in bamboo spine.[229]
Retrospective observational studies suggest that mortality, specifically cardiovascular mortality, is increased in patients with AS.[230][231] The effects of disease duration and severity, comorbidities, and medications on the risk of mortality require further investigation.
Data from a Swedish nationwide population-based study reported increased mortality for men (age-adjusted hazard ratio [HR] 1.53, 95% CI 1.36 to 1.72) and women (age-adjusted HR 1.83, 95% CI 1.50 to 2.22) with AS.[230] Over 7 years, there were 496 deaths in 8600 patients with AS, compared with 1533 deaths in 40,460 matched controls. Cardiovascular disease was the leading cause of death in patients with AS. Predictors of death within the AS cohort included socioeconomic status, general comorbidities, and hip replacement surgery.[230]
AS was associated with increased risk of cardiovascular mortality (adjusted HR for cardiovascular and cerebrovascular death 1.36, 95% CI 1.13 to 1.65) in a Canadian retrospective population-based cohort.[231] Significant risk factors for vascular death were age, male sex, low income, dementia, chronic kidney disease, and peripheral vascular disease.
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