Pulmonary, renal and neurological comorbidities in patients with ankylosing spondylitis; implications for clinical practice

  • Cecilia Mercieca
  • Irene E. van der Horst-Bruinsma
  • Andrew A. Borg
Spondyloarthritis (MA Khan, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Spondyloarthritis


Ankylosing spondylitis (AS) is associated with several comorbidities which contribute significantly to morbidity and mortality and add to the complexity of management. In addition to the well known extra-articular manifestations and increased cardiovascular risk, several pulmonary, renal, and neurological complications which have been associated with AS deserve equal attention. Whereas a clear link has been established for some manifestations, the evidence for other associations is less clear. Interstitial lung disease, apical fibrosis, secondary infection, and ventilatory restriction from reduced chest wall movement are well known pulmonary complications; more recently an association with sleep apnoea has been suggested. Renal amyloidosis and IgA nephropathy remain a treatment challenge which may respond to anti-TNF therapy. Atlanto axial subluxation and vertebral fractures can result in serious neurological complications and are notoriously difficult to diagnose unless a high level of suspicion is maintained. Despite several reports linking AS with demyelination a true link remains to be proved. This review discusses the prevalence, pathophysiology, and management of pulmonary, renal, and neurological complications, and implications for clinical practice.


Spondyloarthritis Ankylosing spondylitis AS Interstitial lung disease Sleep apnoea Pulmonary manifestations Amyloidosis Renal manifestations Neurological manifestations Atlanto axial subluxation Demyelination 


Compliance with Ethics Guidelines

Conflict of Interest

Cecilia Mercieca, Irene E. van der Horst-Bruinsma, and Andrew A. Borg declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Cecilia Mercieca
    • 1
  • Irene E. van der Horst-Bruinsma
    • 2
  • Andrew A. Borg
    • 3
  1. 1.Academic Rheumatology UnitUniversity Hospitals BristolBristolUK
  2. 2.VU University Medical CenterAmsterdamThe Netherlands
  3. 3.Department of Rheumatology, Mater Dei HospitalUniversity of MaltaMsidaMalta

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