{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T20:48:54Z","timestamp":1778014134861,"version":"3.51.4"},"reference-count":34,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,6,28]],"date-time":"2022-06-28T00:00:00Z","timestamp":1656374400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>In this large population\u2010based study we aimed: 1) to assess mortality in patients with ankylosing spondylitis (AS) compared to the general population, considering demographics, comorbidities, and treatment, and 2) to assess factors associated with mortality within patients with AS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study was designed as a retrospective cohort study using the electronic database of the largest health maintenance organization in Israel. All patients with AS diagnosed between 2002 and 2018 were included. Controls were matched by age, sex, clinic, and enrollment time. Follow\u2010up continued until death or the end of the study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study comprised 5,930 AS patients and 29,018 matched controls who were followed up for a median period of 7.5\u2009years. There were 667 deaths within the AS cohort and 2,919 deaths within controls; the mean age at death was 76.9\u2009years and 77.1\u2009years, respectively (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.74). A total of 3,249 AS patients (54.8%) were treated only with nonsteroidal antiinflammatory drugs, 1,760 (29.7%) were treated with tumor necrosis factor inhibitors (TNFi), and 1,687 (28.4%) with disease\u2010modifying antirheumatic drugs (DMARDs). Mortality rates were increased among AS patients compared to controls, with an age\u2010 and sex\u2010adjusted hazard ratio (HR) of 1.19 (95% confidence interval [95% CI] 1.10\u20131.30). The association was significant for men (HR 1.15 [95% CI 1.04\u20131.27]) and women (HR 1.32 [95% CI 1.13\u20131.54]), and after adjusting for background comorbidities (HR 1.14 [95% CI 1.05\u20131.24]). AS patients treated with TNFi or with a combination of TNFi and DMARDs did not have significant difference in mortality rates compared to controls (HR 0.67 [95% CI 0.38\u20131.18] and HR 0.93 [95% CI 0.69\u20131.25], respectively). Age, male sex, mean C\u2010reactive protein (CRP) levels and general comorbidities were predictors of mortality within the AS cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>AS patients had an increased mortality risk compared to the general population after adjusting for age, sex, and baseline comorbidities. AS patients treated with TNFi did not demonstrate excess mortality compared to matched controls. Within the AS cohort, age, male sex, background comorbidities, and higher CRP levels were identified as risk factors for mortality.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.24616","type":"journal-article","created":{"date-parts":[[2021,5,11]],"date-time":"2021-05-11T00:53:22Z","timestamp":1620694402000},"page":"1614-1622","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Mortality in Ankylosing Spondylitis According to Treatment: A Nationwide Retrospective Cohort Study of 5,900 Patients From Israel"],"prefix":"10.1002","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4721-2003","authenticated-orcid":false,"given":"Niv","family":"Ben\u2010Shabat","sequence":"first","affiliation":[{"name":"Sackler Faculty of Medicine Tel\u2010Aviv University, Tel Aviv\u2010Yafo, and Sheba Medical Center  Ramat Gan Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aviv","family":"Shabat","sequence":"additional","affiliation":[{"name":"Hadassah Faculty of Medicine The Hebrew University  Jerusalem Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulla","family":"Watad","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine Tel\u2010Aviv University, Tel Aviv\u2010Yafo, and Sheba Medical Center, Ramat Gan, Israel, and University of Leeds and Chapel Allerton Hospital  Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khalaf","family":"Kridin","sequence":"additional","affiliation":[{"name":"University of L\u00fcbeck, L\u00fcbeck, Germany, and Azrieli Faculty of Medicine, Bar\u2010Ilan University  Safed Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola Luigi","family":"Bragazzi","sequence":"additional","affiliation":[{"name":"Postgraduate School of Public Health University of Genoa, Genoa, Italy, and York University  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis","family":"McGonagle","sequence":"additional","affiliation":[{"name":"University of Leeds and Chapel Allerton Hospital  Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doron","family":"Comaneshter","sequence":"additional","affiliation":[{"name":"Clalit Health Services Tel Aviv  Tel\u2010Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arnon D.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Clalit Health Services Tel Aviv, Tel\u2010Aviv, and Ben Gurion University of the Negev  Beer Sheva Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5406-7716","authenticated-orcid":false,"given":"Howard","family":"Amital","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine Tel\u2010Aviv University, Tel Aviv\u2010Yafo, Sheba Medical Center, Ramat Gan, and Ben Gurion University of the Negev  Beer Sheva Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,6,28]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1406182"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0000000000000475"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0192524"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31591-4"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2007.086777"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2019.01.002"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204021"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2019-000942"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12016-016-8560-9"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2011-201244"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-311214"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.52.3.174"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197709152971103"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-207688"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2011.151191"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-016-3336-4"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.160942"},{"key":"e_1_2_6_19_1","first-page":"404","article-title":"Prevalence of selected chronic diseases in Israel","volume":"3","author":"Rennert G","year":"2001","journal-title":"Isr Med Assoc J"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1080\/2162402X.2019.1588084"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2017.02.135"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-205148"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-017-1497-4"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.190927"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu12051400"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.30581"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.116178"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar2669"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-205322"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2005.041202"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.39298"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210770"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000011250"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1707914"}],"container-title":["Arthritis Care &amp; Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.24616","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acr.24616","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.24616","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T16:00:36Z","timestamp":1759420836000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/acr.24616"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,28]]},"references-count":34,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2022,10]]}},"alternative-id":["10.1002\/acr.24616"],"URL":"https:\/\/doi.org\/10.1002\/acr.24616","archive":["Portico"],"relation":{},"ISSN":["2151-464X","2151-4658"],"issn-type":[{"value":"2151-464X","type":"print"},{"value":"2151-4658","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,28]]},"assertion":[{"value":"2020-08-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}