World Ankylosing Spondylitis Day: Ankylosing spondylitis, an autoimmune disease characterised by painful joint inflammation, inflammatory lower back pain, spinal fusion and impaired spine mobility, causes eye and heart problems. The symptoms of ankylosing spondylitis begin in early adulthood, inflammation in the eyes, called uveitis, being most common.
Uveitis causes rapid-onset eye pain, severe sensitivity to light, blurred vision, and reddening of the eyes, according to Mayo Clinic.
Another common complication of ankylosing spondylitis is heart problems. The autoimmune disease can cause inflammation of the aorta, the largest artery in the body, making it enlarge to a point that the shape of the aortic valve in the heart is distorted, resulting in impaired function of the structure. Therefore, inflammation of the aorta caused by ankylosing spondylitis is linked with increased risk of heart disease.
How ankylosing spondylitis leads to eye problems
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According to experts, uveitis can lead to vision loss and even blindness if left untreated. The most common type of uveitis is anterior uveitis, or iritis, and affects the iris. A 2017 study states that up to 40 per cent of people with ankylosing spondylitis may develop acute iritis.
HLA-B27 can play a role in eye problems in ankylosing spondylitis patients
The HLA-B27 gene, which is associated with an increased risk of ankylosing spondylitis, also plays a role in the development of uveitis. Ankylosing spondylitis also increases the risk of glaucoma and cataracts, and medications such as corticosteroids can aggravate eye conditions.
“Ankylosing spondylitis can also lead to eye inflammation known as uveitis, which can result in vision loss and even blindness if left untreated. Anterior uveitis, or iritis, is the most common type of uveitis and affects the iris, the coloured tissue in the front of the eye. In fact, up to 40% of people with ankylosing spondylitis may develop acute anterior uveitis, as per a 2017 study. “HLA-B27, a gene associated with ankylosing spondylitis, also plays a role in the development of uveitis. Moreover, individuals with inflammatory types of arthritis, such as ankylosing spondylitis, have a higher risk of glaucoma and cataracts. Corticosteroid use can further increase the risk of these eye conditions. It is worth noting that certain genetic variations linked to inflammatory conditions like ankylosing spondylitis may also raise the risk of developing cataracts. Lastly, taking steroids to manage certain health conditions can increase the likelihood of experiencing these eye problems,” Dr Harpreet Singh, Spine Surgeon, Regency Hospitals, Kanpur, told ABP Live.
Immune system of ankylosing spondylitis patients can attack healthy eye tissues
When the immune system is fighting an infection, or if the immune system attacks healthy tissues in eyes, uveitis can occur.
“Eyes can be affected due to ankylosing spondylitis. There can be redness, swelling, inflammation, pain, blurred vision, sensitivity to light and even loss of vision is possible. Uveitis, an eye inflammation is one of the complications caused by ankylosing spondylitis. Rapid-onset eye pain is caused. The patient faces sensitivity to light and blurred vision. Generally, uveitis occurs when our immune system is fighting an infection or if the immune system attacks healthy tissues in the eye,” Dr Amit Deshpande, Founder & Director, Activist, told ABP Live.
Ankylosing spondylitis patients must undergo routine eye tests
Experts recommend that ankylosing spondylitis patients be aware of their eye problems and undergo routine eye tests to identify and prevent major problems.
“Uveitis, which results in pain, redness, and light sensitivity in the affected eye, can be brought on by inflammation associated with ankylosing spondylitis. Uveitis may result in blindness or vision loss if untreated. To identify and stop major consequences, people with ankylosing spondylitis should be aware of potential eye issues and have routine eye tests,” Dr Ravindra Srivastava, Director, Neurosciences, Primus Super Speciality Hospital, New Delhi, told ABP Live.
About 40 per cent of ankylosing spondylitis patients can have inflammatory eye disorders
Inflammatory disorders of the eye occur in about 40 per cent of ankylosing spondylitis patients. Also, ankylosing spondylitis patients who are positive for the HLA-B27 gene show high incidence of uveitis. Therefore, they should seek medical help from both rheumatologists and ophthalmologists. These patients are often recommended immunosuppressants, because ankylosing spondylitis is an autoimmune disease.
“Ankylosing spondylitis is associated with several problems outside of joints too. Inflammatory disorders of the eye can be present in about 40% of these patients. Uveitis , usually acutely presented as a sudden painful red eye, is the most common of these issues. Untreated uveitis can lead to complications and even carries the risk of blindness. Uveitis can present in one eye or both eyes and sometimes can have a ping pong presentation with alternate eyes being affected. The incidence of HLA-B27 positivity in patients with ankylosing spondylitis and uveitis is also quite high. These patients need to be treated concurrently by both rheumatologist and ophthalmologist. Treatment involves various medications that come under the spectrum of systemic immunosuppressants, so expert follow-up is also important,” Dr. Suma Balan, Consultant Paediatric Rheumatologist, Rheumatology and Clinical Immunology, Amrita Hospital, Kochi, told ABP Live.
How ankylosing spondylitis leads to heart problems
According to experts, inflammation of the aorta in ankylosing spondylitis patients can lead to high blood pressure and aortic valve disease, which occurs when the valve between the main pumping chamber of the heart and aorta does not function properly, resulting in shortness of breath, chest pain and dizziness. The valve leaks more in patients already suffering from hypertension.
Ankylosing spondylitis patients are at risk for other heart conditions such as heart arrhythmias, and cardiomyopathy, which refers to the problems with the heart muscle that make it difficult for the heart to pump blood.
Ischemic heart disease, or coronary artery disease, can also occur in ankylosing spondylitis patients. Ischemic heart disease affects the coronary arteries, which supply blood to the heart muscle. The coronary arteries become narrow, as a result of which the heart does not get enough blood and oxygen.
“Ankylosing spondylitis can cause inflammation that damages joints and other organs, including the heart. The aorta, the large artery that carries blood from the heart to the rest of the body, is particularly vulnerable. Over time, inflammation of the aorta can lead to high blood pressure and aortic valve disease, which occurs when the valve between the heart’s main pumping chamber and the aorta does not function properly, causing shortness of breath, chest pain, and dizziness. If you already have high blood pressure, the valve may leak even more. People with ankylosing spondylitis are also at risk for other heart conditions, such as heart arrhythmias, which can cause the heart to beat too fast or too slow. In addition, cardiomyopathy can cause the heart muscle to enlarge and weaken, making it harder to pump blood throughout the body, and ischemic heart disease can reduce blood supply to the heart muscle,” Dr Singh said.
He also explained that while inflammation may be a common factor in both ankylosing spondylitis and heart disease, other factors can also increase the risk of developing heart disease. “For instance, some medications used to manage ankylosing spondylitis, like non-steroidal anti-inflammatory drugs (NSAIDs), may also heighten the risk of heart disease.”
Ankylosing patients can suffer from arteriosclerosis
Aorta problems, caused by ankylosing spondylitis, can result in chest pain and breathlessness. Ankylosing patients are at a 60 per cent increased risk of developing a stroke. Arteriosclerosis, a condition in which arteries become damaged due to the buildup of cholesterol and fats, high blood pressure and some genetic factors can also occur in ankylosing spondylitis patients.
“Ankylosing spondylitis causes issues in the aorta. Issues here can cause problems like blood pressure and aortic wall disease. Chest pain and breathlessness are some problems as well. An inflamed aorta enlarges and distorts the shape of the aortic valve in the heart. The chances of developing a stroke in ankylosing spondylitis patients increase by 60%. Heart-related issues like heart arrhythmia, cardiomyopathy, ischemic heart disease, and arteriosclerosis can occur as well,” Dr Deshpande said.
Different heart inflammatory problems associated with ankylosing spondylitis
Some experts state that the “magnitude” of the relationship between heart disease and ankylosing spondylitis is less clear. The three types of inflammatory problems that can occur in ankylosing spondylitis patients are: aortitis, the pathologic term for the inflammation of the aortic wall, and aortic insufficiency, a valvular heart disease which causes the retrograde or backward flow of blood back into the left ventricle, that pumps oxygenated blood into the body; conduction disturbances of the atrioventricular node, a structure which connects the electrical systems of the atria (receive oxygen-rich or oxygen-poor blood) and the ventricles; and myocardial infarction (heart attack), a condition in which there is a blockage of blood flow to the heart muscle.
HLA-B27 gene can cause aortic root disease
The HLA-B27 gene is also associated with aortic root disease, a disease of the section of the aorta closest to and attached to the heart, and conduction abnormalities.
“There is a definite association of heart disease with ankylosing spondylitis. The magnitude of this relationship is less clear. Three types of inflammatory affections can be differentiated: aortitis and aortic insufficiency with the possible necessity of cardiac surgery, conduction disturbances of the atrioventricular node with a probable subsequent indication for a pacemaker, and myocardial involvement with a possible compromise of left ventricular function. There seems to be an HLA-B27-associated cardiac syndrome consisting of aortic root disease and conduction abnormalities. Patients can be recognized at preclinical stages. Prospective studies have not been performed. HLA B27-related heart disease does not seem to be associated with increased mortality,” Dr Srivastava said.
Chances of heart attacks and strokes are high in ankylosing spondylitis patients
According to experts, about two to 10 per cent of ankylosing spondylitis patients can suffer from heart problems such as aortitis, aortic regurgitation, a term for the inflammation and leak of the aortic valve, and cardiomyopathy. When inflammation in ankylosing spondylitis patients is left untreated, the chances of heart attacks and strokes increases.
“About 2-10% of patients with ankylosing spondylitis can have heart involvement in the form of aortitis, inflammation and leak of the aortic valve called aortic regurgitation, rhythm disturbances or affectation of the muscle pumping ability of the heart called cardiomyopathy. Untreated and prolonged inflammation in patients with ankylosing spondylitis also increases the risk of heart attacks and strokes,” Dr Balan said.
Dr Balan concluded that,it is not unusual for the treating rheumatologist to request for a check of the function of the heart with electrocardiogram, echocardiogram and other modalities.
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