The prevalence and impact of comorbidities on patients with axial spondyloarthritis: results from a nationwide population-based study.
Axial spondyloarthritis
Comorbidity
Disease activity
Functional status
Multimorbidity
Journal
Arthritis research & therapy
ISSN: 1478-6362
Titre abrégé: Arthritis Res Ther
Pays: England
ID NLM: 101154438
Informations de publication
Date de publication:
10 09 2020
10 09 2020
Historique:
received:
14
04
2020
accepted:
24
08
2020
entrez:
11
9
2020
pubmed:
12
9
2020
medline:
22
6
2021
Statut:
epublish
Résumé
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. A 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. A 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. Comorbidities 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.
Sections du résumé
BACKGROUND
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.
METHODS
A 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.
RESULTS
A 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.
CONCLUSIONS
Comorbidities 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.
Identifiants
pubmed: 32912264
doi: 10.1186/s13075-020-02301-0
pii: 10.1186/s13075-020-02301-0
pmc: PMC7488243
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
210Références
J Rheumatol. 1994 Dec;21(12):2286-91
pubmed: 7699630
Semin Arthritis Rheum. 2009 Feb;38(4):312-9
pubmed: 18336872
Psychother Psychosom. 2015;84(3):167-76
pubmed: 25831962
Arthritis Care Res (Hoboken). 2018 Aug;70(8):1257-1262
pubmed: 29125900
Lancet. 2017 Jul 1;390(10089):73-84
pubmed: 28110981
Rheumatology (Oxford). 2009 Aug;48(8):906-10
pubmed: 19478038
Arthritis Care Res (Hoboken). 2014 Jul;66(7):980-9
pubmed: 24339352
N Engl J Med. 1998 May 21;338(21):1516-20
pubmed: 9593791
Med Care. 1998 Jan;36(1):8-27
pubmed: 9431328
Arthritis Care Res (Hoboken). 2012 Sep;64(9):1415-22
pubmed: 22505331
J Rheumatol. 2019 Jun;46(6):564-571
pubmed: 30647170
Lancet. 2012 Jul 7;380(9836):37-43
pubmed: 22579043
Z Rheumatol. 2019 Nov;78(9):865-874
pubmed: 31172266
Med Care. 2004 Apr;42(4):355-60
pubmed: 15076812
Ann Rheum Dis. 2010 Jun;69(6):1165-8
pubmed: 20375121
Ann Rheum Dis. 2016 Jun;75(6):1016-23
pubmed: 26489703
Rheumatology (Oxford). 2019 Oct 1;58(10):1746-1754
pubmed: 31220322
Arthritis Rheum. 2005 Oct 15;53(5):666-72
pubmed: 16208675
Arthritis Rheum. 2013 Dec;65(12):3096-106
pubmed: 23983141
J Rheumatol. 1994 Dec;21(12):2281-5
pubmed: 7699629
Med Care. 2015 Sep;53(9):e65-72
pubmed: 23703645
Ann Rheum Dis. 2018 Jul;77(7):1017-1024
pubmed: 29525776
Best Pract Res Clin Rheumatol. 2018 Jun;32(3):390-400
pubmed: 31171310
Ann Rheum Dis. 2009 Jun;68(6):777-83
pubmed: 19297344
BMC Public Health. 2013 Dec 10;13:1161
pubmed: 24325303
Arthritis Rheum. 2009 Mar;60(3):717-27
pubmed: 19248087
Ann Rheum Dis. 2006 Sep;65(9):1226-9
pubmed: 16414968
J Rheumatol. 2020 Feb;47(2):218-226
pubmed: 31092715
J Rheumatol. 2015 Jul;42(7):1099-104
pubmed: 26034147
Med Care. 2005 Nov;43(11):1130-9
pubmed: 16224307