Uveitis increases the risk of stroke among patients with ankylosing spondylitis: A nationwide population-based longitudinal study

Ta-Hsin Tsung; Ke-Hao Huang; Wu-Chien Chien; Yi-Hao Chen; I-Chuan Yen; Chi-Hsiang Chung; Jiann-Torng Chen; Ching-Long Chen

doi:10.3389/fimmu.2022.959848

Uveitis increases the risk of stroke among patients with ankylosing spondylitis: A nationwide population-based longitudinal study

Front Immunol. 2022 Oct 6:13:959848. doi: 10.3389/fimmu.2022.959848. eCollection 2022.

Authors

Ta-Hsin Tsung¹, Ke-Hao Huang², Wu-Chien Chien^{3

4

5}, Yi-Hao Chen¹, I-Chuan Yen⁶, Chi-Hsiang Chung^{3

4

7}, Jiann-Torng Chen¹, Ching-Long Chen¹

Affiliations

¹ Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
² Department of Ophthalmology, Song-Shan Branch of Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
³ Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁴ School of Public Health, National Defense Medical Center, Taipei, Taiwan.
⁵ Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
⁶ School of Pharmacy, National Defense Medical Center, Taipei, Taiwan.
⁷ Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.

Abstract

Ankylosing spondylitis (AS) is known to increase the risk of stroke. Among patients with AS, uveitis is the most common extra-articular manifestation. However, no previous investigations have discussed the association between uveitis and the risk for developing stroke in patients with AS. This retrospective cohort study aimed to explore the relationship between uveitis and the incidence of stroke in patients with AS by obtaining medical records from January 1, 2000, to December 31, 2015, from the National Health Insurance Research Database, according to the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. The primary outcome was the incidence of stroke. Pearson's chi-square test and Fisher's exact test were used to analyze variables. Kaplan-Meier survival curves and univariate and multivariate Cox proportional hazard regression models with and without Fine and Gray's competing risk model were used to analyze data. Total 828 AS patients with uveitis and 3,312 AS patients without uveitis were identified. During the follow-up period, 137 patients in the uveitis group and 344 in the non-uveitis group developed stroke. Uveitis is a significant risk factor for stroke development in patients with AS (adjusted hazard ratio = 1.846, p < 0.001). Age, diabetes mellitus, hyperlipidemia, hypertension, congestive heart failure, chronic obstructive pulmonary disease, asthma, coronary artery disease, and atrial fibrillation were associated with a higher risk of stroke. After subgroup analysis, both anterior uveitis and posterior segment involvement were found to increase the risk of stroke in patients with AS. Uveitis is associated with an increased risk in both ischemic and hemorrhagic strokes in patients with AS. Therefore, when uveitis is identified, clinicians should pay more attention to the cerebrovascular risk in patients with AS, especially in those with underlying comorbidities.

Keywords: ankylosing spondylitis; cerebrovascular disease; epidemiology; stroke; uveitis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Longitudinal Studies
Retrospective Studies
Spondylitis, Ankylosing* / complications
Spondylitis, Ankylosing* / diagnosis
Spondylitis, Ankylosing* / epidemiology
Stroke* / epidemiology
Stroke* / etiology
Uveitis* / complications
Uveitis* / epidemiology