Association between comorbidities and disease activity in axial spondyloarthritis: results from the BSRBR-AS

Zhao, Sizheng Steven ORCID: 0000-0002-3558-7353, Jones, Gareth T, Macfarlane, Gary J, Hughes, David M ORCID: 0000-0002-1287-9994, Moots, Robert J ORCID: 0000-0001-7019-6211 and Goodson, Nicola J ORCID: 0000-0003-0714-3568 (2021) Association between comorbidities and disease activity in axial spondyloarthritis: results from the BSRBR-AS. RHEUMATOLOGY, 60 (7). pp. 3189-3198.

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Official URL: http://dx.doi.org/10.1093/rheumatology/keaa768

Abstract

<h4>Objective</h4>Whether comorbidities influence disease activity assessment in axial SpA (axSpA) is unclear. Comorbidities inflate DAS28 in rheumatoid arthritis through the patient global score. We examined whether axSpA disease activity measures are differentially affected, and whether comorbidities inflate the AS disease activity score (ASDAS) through the patient global component.<h4>Methods</h4>We used baseline data from the British Society for Rheumatology Biologics Register for AS, including 14 physician diagnosed comorbidities. Linear models were used to compare disease activity (BASDAI, spinal pain, ASDAS) and ESR/CRP according to comorbidity count, adjusted for age, gender, BMI, smoking, socioeconomic status, and education. The same models were used to examine whether the patient global score was associated with comorbidities, additionally adjusting for other ASDAS components.<h4>Results</h4>The number of participants eligible for analysis was 2043 (67% male, mean age 49 years); 44% had at least one comorbidity. Each additional comorbidity was associated with higher BASDAI by 0.40 units (95% CI: 0.27, 0.52) and spinal pain by 0.53 (95% CI: 0.37, 0.68). Effect size for ASDAS (0.09 units; 95% CI: 0.03, 0.15) was not clinically significant. ESR and CRP were not associated with comorbidity count. Depression, heart failure and peptic ulcer were consistently associated with higher disease activity measures, but not CRP/ESR. Patient global was associated with comorbidity count, but not independently of other ASDAS components (P = 0.75).<h4>Conclusion</h4>Comorbidities were associated with higher patient reported disease activity in axSpA. Clinicians should be mindful of the potential impact of comorbidities on patient reported outcome measures and consider additionally collecting ASDAS when comorbidities are present.

Item Type:	Article
Uncontrolled Keywords:	axial spondylarthritis, AS, comorbidity, disease activity, patient global
Depositing User:	Symplectic Admin
Date Deposited:	18 Dec 2020 08:33
Last Modified:	18 Jan 2023 23:06
DOI:	10.1093/rheumatology/keaa768
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3110249