TOPLINE:

Patients with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) had an increased risk for all-cause mortality compared with the general population, with a higher risk noted in those with axSpA vs PsA. Treatment with biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) was associated with a reduced risk for mortality among patients with axSpA and PsA.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using electronic health records from the TriNetX Global Collaborative Network to assess all-cause mortality in patients with axSpA and PsA.
• They included 32,368 adults with axSpA (mean age, 47.3 years; 62% men) and 52,402 with PsA (mean age, 52.0 years; 51% women), identified by at least two relevant diagnostic codes for ankylosing spondylitis and arthropathic psoriasis, respectively, between 2010 and 2020; all patients had at least one follow-up visit after diagnosis.
• A general hospital population cohort of 9,742,949 adults (mean age, 47.2 years) without rheumatologic conditions was included, each with at least three non-disease-specific encounters during the same period and at least one follow-up visit at least 6 months later.
• Propensity score matching (1:1) was used to balance age, sex, and race across cohorts and to adjust for baseline comorbidities.
• The primary outcome was all-cause mortality identified using death-related codes in the electronic health records, with the risk for mortality compared between axSpA and PsA and between each cohort and the general population; the effect of b/tsDMARD treatment was also assessed.

TAKEAWAY:

• Patients with axSpA had a 71% higher risk for all-cause mortality (hazard ratio [HR], 1.71; 95% CI, 1.61-1.81) and those with PsA had a 26% higher risk (HR, 1.26; 95% CI, 1.20-1.32) than those in the matched general population.
• Patients with axSpA exhibited a 42% higher risk for mortality than those with PsA, with cumulative mortality rates of 9.9% and 7.2% noted over median follow-up durations of 6.2 and 6.4 years, respectively.
• Men with axSpA and those with PsA had a 65% (HR, 1.65; 95% CI, 1.49-1.84) and 26% (HR, 1.26; 95% CI, 1.18-1.36) higher risk for all-cause mortality, respectively, than women with the respective diagnosis.
• Treatment with b/tsDMARDs was associated with a reduced risk for mortality in patients with axSpA (HR, 0.53; 95% CI, 0.45-0.63) and in those with PsA (HR, 0.62; 95% CI, 0.56-0.69) compared with no treatment; treatment with TNF inhibitors was associated with a 48% and 36% reduction in the risk for mortality in patients with axSpA and PsA, respectively.

IN PRACTICE:

"Taken together with the low mortality risk observed among patients receiving bDMARDs, these findings suggest that the increased mortality risk in axSpA may be driven more by disease-specific or genetic factors rather than by cardiometabolic comorbidity burden, although further targeted studies are required," the authors wrote.

SOURCE:

This study was led by Maria Llop, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Barcelona, Spain. It was published online on March 13, 2026, in RMD Open.

LIMITATIONS:

Diagnostic codes were used for the identification of patients and the assessment of outcomes, which may have led to misclassification. The lack of disease activity data limited the assessment of disease severity, and residual confounding may have persisted despite propensity score matching.

DISCLOSURES:

This study did not report any specific funding. Some authors declared receiving consultancy fees, speaker honoraria, advisory board honoraria, and/or travel support for meetings and participating in clinical trials sponsored by multiple pharmaceutical companies, including AbbVie, Amgen, Novartis, Pfizer, and others.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.