Comorbidity burden in axial spondyloarthritis: a cluster analysis

Author:

Zhao Sizheng Steven123ORCID,Radner Helga4,Siebert Stefan5,Duffield Stephen J1,Thong Daniel2,Hughes David M6,Moots Robert J12ORCID,Solomon Daniel H37,Goodson Nicola J12

Affiliation:

1. Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool

2. Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK

3. Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA, USA

4. Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria

5. Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow

6. Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK

7. Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA, USA

Abstract

Abstract Objectives To examine how comorbidities cluster in axial spondyloarthritis (axSpA) and whether these clusters are associated with quality of life, global health and other outcome measures. Methods We conducted a cross-sectional study of consecutive patients meeting ASAS criteria for axSpA in Liverpool, UK. Outcome measures included quality of life (EQ5D), global health and disease activity (BASDAI). We used hierarchical cluster analysis to group patients according to 38 pre-specified comorbidities. In multivariable linear models, the associations between distinct comorbidity clusters and each outcome measure were compared, using axSpA patients with no comorbidities as the reference group. Analyses were adjusted for age, gender, symptom duration, BMI, deprivation, NSAID-use and smoking. Results We studied 419 patients (69% male, mean age 46 years). 255 patients (61%) had at least one comorbidity, among whom the median number was 1 (range 1–6). Common comorbidities were hypertension (19%) and depression (16%). Of 15 clusters identified, the most prevalent clusters were hypertension-coronary heart disease and depression-anxiety. Compared with patients with no comorbidities, the fibromyalgia-irritable bowel syndrome cluster was associated with adverse patient-reported outcome measures; these patients reported 1.5-unit poorer global health (95%CI 0.01, 2.9), reduced quality of life (0.25-unit lower EQ5D; 95%CI −0.37, −0.12) and 1.8-unit higher BASDAI (95% CI 0.4, 3.3). Similar effect estimates were found for patients in the depression-anxiety cluster. Conclusion Comorbidity is common among axSpA patients. The two most common comorbidities were hypertension and depression. Patients in the depression-anxiety and fibromyalgia-IBS clusters reported poorer health and increased axSpA severity.

Funder

National Institute of Health

NIH

Publisher

Oxford University Press (OUP)

Subject

Pharmacology (medical),Rheumatology

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