Abstract

BackgroundIn contrast to other chronic rheumatic musculoskeletal diseases such as rheumatoid arthritis, comorbidities in axial spondyloarthritis (axSpA) and their impact on disease outcomes are less well studied. The aim of this study was to investigate the prevalence of comorbidities and their association with disease activity and functional impairment in a large population-based cohort of patients with axSpA.MethodsA random sample of patients with axSpA, stratified by age and sex, was drawn from health insurance data. Patients in the sample received a survey on demographic, socioeconomic, and disease-related parameters. Comorbidities were defined using the Elixhauser coding algorithms excluding rheumatoid arthritis/collagen vascular diseases and including osteoporosis and fibromyalgia, resulting in a set of 32 comorbidities. The prevalence of comorbidities in the axSpA patients and their pharmacological treatment were examined. Multivariable linear regression models were calculated to determine the association of comorbidities with disease activity and functional status.ResultsA total of 1776 axSpA patients were included in the analyses (response, 47%; mean age, 56 years; 46% female). The most prevalent comorbidities were hypertension, depression, and chronic pulmonary disorders. The number of comorbidities was significantly associated with both the BASDAI and BASFI: β (95% CI) = 0.17 (0.09–0.24) and 0.24 (0.15–0.32), respectively. When analysed separately, hypertension, depression, and chronic pulmonary disease were comorbidities with a significant and independent association with BASFI, while for BASDAI, such an association was found for depression and chronic pulmonary disease only.ConclusionsComorbidities are common in axSpA patients and are associated with higher disease activity and higher levels of functional impairment. Higher disease activity and higher levels of functional impairment might be indicators of severe disease resulting in the development of comorbidities.

Highlights

  • IntroductionAxial spondyloarthritis (axSpA) is a term that encompasses chronic inflammatory diseases characterised by predominant involvement of the spine and/or sacroiliac joints, including non-radiographic axial spondyloarthritis (axSpA) (nr-axSpA, i.e. axSpA without definite radiographic sacroiliitis) and radiographic axSpA ( termed ankylosing spondylitis (AS), characterised by the presence of radiographic sacroiliitis according to the modified New York criteria) [1]

  • Axial spondyloarthritis is a term that encompasses chronic inflammatory diseases characterised by predominant involvement of the spine and/or sacroiliac joints, including non-radiographic axial spondyloarthritis (axSpA) and radiographic axSpA ( termed ankylosing spondylitis (AS), characterised by the presence of radiographic sacroiliitis according to the modified New York criteria) [1]

  • The overall burden of comorbidities and disease activity/function are significantly associated in axial spondyloarthritis patients

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Summary

Introduction

Axial spondyloarthritis (axSpA) is a term that encompasses chronic inflammatory diseases characterised by predominant involvement of the spine and/or sacroiliac joints, including non-radiographic axSpA (nr-axSpA, i.e. axSpA without definite radiographic sacroiliitis) and radiographic axSpA ( termed ankylosing spondylitis (AS), characterised by the presence of radiographic sacroiliitis according to the modified New York criteria) [1]. Peripheral symptoms (peripheral arthritis, enthesitis, dactylitis) might be present as well as extramusculoskeletal manifestations such as inflammatory bowel disease, psoriasis, and uveitis, contributing to the total burden of axSpA [2]. In addition to those manifestations, which are directly related to axSpA, patients may suffer from other diseases referred to as comorbidities [3]. In contrast to other chronic rheumatic musculoskeletal diseases such as rheumatoid arthritis, comorbidities in axial spondyloarthritis (axSpA) and their impact on disease outcomes are less well studied. The aim of this study was to investigate the prevalence of comorbidities and their association with disease activity and functional impairment in a large population-based cohort of patients with axSpA

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