Evolving trends in the prevalence and treatment of ankylosing spondylitis in Korea from 2010 to 2023: a population-based study

Abstract

Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting the axial skeleton, resulting in severe pain, decreased mobility, and irreversible structural damage. This study explores the evolving prevalence, patient demographics, and treatment trends for AS in the Korean population from 2010 to 2023, alongside advancements in targeted therapies. This population-based study utilized data from the National Health Insurance Database covering 2010 to 2023. AS cases were identified using at least two ICD-10 (International Classification of Diseases, 10th Revision) codes and rare intractable disease registration codes, excluding diagnoses of rheumatoid arthritis and systemic lupus erythematosus. The annual prevalence of AS was calculated and standardized to the 2017 population. Patient characteristics, comorbidities, and treatment patterns were assessed. The prevalence of AS increased from 26.76 per 100,000 individuals in 2010 to 81.87 per 100,000 in 2023. The proportion of patients over 50 years rose from 19.5 to 32.5%, and female representation increased from 17.9 to 24.0%. Comorbidities such as metabolic syndrome and musculoskeletal complications became more prevalent. Tumor necrosis factor-alpha inhibitor prescriptions rose from 29.7 to 41.6%, while the use of conventional synthetic disease-modifying antirheumatic drugs declined. The introduction of interleukin-17 and Janus kinase (JAK) inhibitors, particularly as second- and third-line therapies, marked a significant development. The prevalence of AS has surged between 2010 and 2023, particularly among older and female patients. The concurrent rise in comorbidities underscores the need for integrated care. Future research should focus on optimizing therapeutic sequences and evaluating long-term outcomes in this changing patient population.