All-Cause and Cause-Specific Mortality in Psoriatic Arthritis and Ankylosing Spondylitis: A Systematic Review and Meta-Analysis

Introduction: Psoriatic Arthritis (PsA) and Ankylosing spondylitis (AS) are chronic inflammatory diseases associated with a higher risk of cardio-metabolic comorbidities compared to the general population. Individual studies examining mortality in these patients have produced conflicting results. We performed a systematic review and meta-analysis to analyze the all-cause and cause-specific mortality in PsA and AS from the available literature. Methods: A comprehensive database search was performed for studies reporting all-cause or cause-specific mortality in patients with PsA and AS compared with the general population. Pooled relative risks (RRs) were calculated using random-effects model. Results: We included 19 studies (11 of PsA, 7 of AS, 1 of both). In PsA studies, there was no increased mortality compared to the general population (RR: 1.12, 95% CI: 0.96-1.30, 10 studies). We found a higher all-cause mortality in females (RR= 1.19, 95% CI: 1.04-1.36) but not in male (RR: 1.02, 95% CI 0.66-1.59) PsA patients. Cardiovascular, respiratory, and infection specific mortality risks were significantly higher for PsA patients (RR: 1.21, 95% CI: 1.06-1.38; RR: 3.37, 95% CI: 1.30-8.72; and 2.43, 95% CI: 1.01-5.84, respectively), but not cancer-related mortality (RR: 1.01, 95% CI: 0.91-1.11). In AS, we found a higher risk of death from all causes (RR 1.64, 95% CI: 1.49-1.80, 6 studies) and cardiovascular causes (RR 1.35, 95% CI: 1.01-1.81, 3 studies) compared to the general population. All-cause mortality was high in both males (RR 1.56, 95% CI: 1.43-1.71) and female (RR 1.85, 95% CI: 1.56-2.18) AS patients. The included AS studies did not report mortality data for non-cardiovascular causes. Conclusion: This systematic review and meta-analysis showed a significantly increased risk of overall mortality in AS, but not PsA. Cardiovascular-specific mortality was higher for both PsA and AS, which emphasizes the importance of early screening and management of cardiovascular risk factors. This article is protected by copyright. All rights reserved.