Chronic inflammatory burden on aortic valve disorders and atrioventricular block risk in SpA: an ambispective cohort study.

Abstract

To assess the impact of chronic inflammatory burden on the risk of aortic valve outcomes and atrioventricular block (AVB) in SpA. Ambispective cohort study of 461 SpA patients meeting ASAS criteria between September 2022 and April 2024. Chronic inflammation burden was measured by symptom duration, number of DMARDs discontinued due to inefficacy and total exposure to persistent inflammation. Statistical analysis was performed with multiple time-dependent Cox regression, maintaining a variable-to-event ratio. Disease duration, especially from initial musculoskeletal (MSK) symptoms, affected all outcomes. Every five-year increase in symptom duration raised the risk of aortic regurgitation (HR 1.21, 95% CI 1.06-1.37), valve sclerosis (HR 1.07, 95% CI 1.02-1.12), root dilation (HR 1.31, 95% CI 1.08-1.59) and AVB (HR 1.34, 95% CI 1.05-1.71). Age also increased risks, particularly for aortic regurgitation (HR 1.46 per decade) and valve sclerosis (HR 1.74 per decade). Surprisingly, hypertension showed a consistent protective effect, decreasing the risk for aortic root dilation (HR 0.55, 95% CI 0.36-0.84), valve sclerosis (HR 0.62, 95% CI 0.40-0.96) and aortic regurgitation (HR 0.60, 95% CI 0.37-0.98). Peripheral SpA significantly predicted aortic valve sclerosis (HR 1.95, 95% CI 1.13-3.36), and enthesitis strongly influenced AVB risk (HR 3.04, 95% CI 1.24-7.44). The duration of MSK symptoms more strongly predicted all outcomes than extra-MSK symptoms. Age's impact mirrored general population trends. Surprisingly, hypertension protected against aortic conditions, prompting further research into IL-17 therapies. Peripheral SpA significantly predicted aortic valve sclerosis, and enthesitis strongly predicted AVB.