The epidemiology of extra-articular manifestations in ankylosing spondylitis: a population-based matched cohort study

C. Stolwijk, I. Essers, A. van Tubergen, A. Boonen, M.T. Bazelier, M.L. de Bruin, F. de Vries*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objective To assess the incidence and risks of common extra-articular manifestations (EAMs), that is, acute anterior uveitis (AAU), psoriasis and inflammatory bowel disease (IBD), in patients with ankylosing spondylitis (AS) compared with population-based controls.

Methods All incident patients with AS (n=4101) from the UK Clinical Practice Research Datalink (1987-2012) were matched with up to seven control subjects without AS by year of birth, sex and practice (n=28 591). Incidence rates, cumulative incidence rates and adjusted (adj) HRs for the development of EAMs were calculated, with time-dependent adjustments for age, sex, comorbidity and medication use.

Results At diagnosis of AS, the proportion of patients with an EAM was 11.4% for AAU, 4.4% for psoriasis and 3.7% for IBD. Incidence rates of EAMs were 8.9/ 1000 person-years for AAU, 3.4/1000 person-years for psoriasis and 2.4/1000 person-years for IBD in AS. The 20-year cumulative incidence was 24.5%, 10.1% and 7.5%, respectively. Risks of EAMs were 1.5-fold to 16-fold increased versus controls, with an adj HR of 15.5 (95% CI 11.6 to 20.7) for AAU, adj HR of 1.5 (95% CI 1.1 to 1.9) for psoriasis and adj HR of 3.3 (95% CI 2.3 to 4.8) for IBD. For psoriasis and IBD, the highest risks were found in the 1st years after diagnosis, while developing AAU continued to be increased also 10 years after diagnosis of AS.

Conclusions The risk of, in particular AAU, but also of psoriasis and IBD, is significantly increased in patients with AS compared with controls. Hazard patterns are different for each of the EAMs.

Original languageEnglish
Pages (from-to)1373-1378
Number of pages6
JournalAnnals of the Rheumatic Diseases
Issue number7
Early online date21 Mar 2014
Publication statusPublished - Jul 2015




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