Impact of Comorbidities on Disease Activity, Patient Global Assessment, and Function in Psoriatic Arthritis: A Cross-Sectional Study

Abstract

Introduction The aim of this study was to evaluate the impact of comorbidities on disease activity, patient’s impact of the disease, patient global assessment, and function in psoriatic arthritis (PsA). Methods Consecutive PsA patients were enrolled in this cross-sectional study. During the visit, the patients underwent a complete physical examination and clinical/laboratory data were collected, including type and number of comorbidities, recorded as simple comorbidity count (SCC). Disease activity was assessed using the Disease Activity Score for Psoriatic Arthritis (DAPSA) and the Minimal Disease Activity (MDA) was also evaluated. The Psoriatic Arthritis Impact of Disease (PsAID), the Health Assessment Questionnaire-Disability Index (HAQ-DI), and the Patient Global Assessment of disease activity (PtGA) were also collected. Results A total of 144 patients were enrolled. At least one comorbidity was registered in 104 (72.2%) patients. The SCC was associated with DAPSA ( β = 1.48, p = 0.013), PsAID ( β = 0.41, p < 0.01), HAQ-DI ( β = 0.11, p < 0.01) and PtGA ( β = 0.50, p < 0.01). The comorbidities that showed an impact on outcome measures were anxiety and fibromyalgia (FM). Anxiety showed an impact on DAPSA ( β = 14.46, p < 0.001), PsAID ( β = 1.98, p = 0.039) and HAQ-DI ( β = 0.54, p = 0.036). FM showed an impact on DAPSA ( β = 6.46, p = 0.025), PsAID ( β = 2.88, p < 0.001), HAQ-DI ( β = 0.70, p < 0.001), PtGA ( β = 2.00, p = 0.014), and MDA ( β = − 2.79, p = 0.01). The median PtGA value was different among patients with different numbers of comorbidities . Conclusions This study showed that comorbidities, either as a simple comorbidity count number or as single comorbidity, might have an impact on the main domains affecting PsA patients in real clinical practice.

Clinical Characteristics of Psoriatic Arthritis in Chinese Patients: A Cross-Sectional Study

“…A recent study also showed that high prevalence of metabolic syndrome in PsA was associated with the severity of PsA [27]. Also, Ennio Lubrano et al found that anxiety (b = 14.46, p \ 0.001) and fibromyalgia (b = 6.46, p = 0.025) was also positively correlated to DAPSA [28]. The association of comorbidities with disease activity warrants a prospective longitudinal study to confirm their casual relationships.…”

“…On the other hand, PsA patients with hypertension or cardiovascular disease are more unlikely to achieve remission/LDA [ 29 ]. Several studies have shown the increased risk of cardiovascular disease in PsA patients [ 30 , 31 ]. Therefore, we highly recommend screening for comorbidities in PsA patients, especially those with more active disease.…”

Comparisons of Comorbidities in Patients with Ankylosing Spondylitis and Psoriatic Arthritis and their Influence on Psoriatic Arthritis Disease Activity: Results of a Multicentre Longitudinal Study

“…In our study, the leptin level, obesity, and depression predicted persistent clinical PsA activity. Recently, Lubrano et al [29] demonstrated that the number of comorbidities, including general comorbidities, anxiety and bromyalgia in particular, had an impact on the DAPSA scores. Other comorbidities, such as depression, diabetes and obesity, did not in uence activity [29].…”

Clinical Characteristics of Potential “Difficult-to-treat” Patients with Psoriatic Arthritis: A Retrospective Analysis of a Longitudinal Cohort

“…Inflammatory activity in one or more disease domains may persist due to multidrug resistance, clinical or immunologic mechanisms (including anti-drug antibodies), or other factors such as non-adherence. On the other hand, factors such as comorbidity and in particular fibromyalgia, anxiety, and depression may play a role, making a patient resistant to multiple treatment strategies [ 10 – 12 ]. In RA, a recent international survey showed the need for a more holistic approach for the D2T patient [ 13 ].…”