Impact of Comorbidity on Physical Function in Patients With Ankylosing Spondylitis and Psoriatic Arthritis Attending Rheumatology Clinics: Results From a Cross‐Sectional Study

Abstract

Objective. To evaluate the impact of comorbidities on physical function in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA).Methods. This was a cross-sectional analysis of the baseline visit from the Cardiovascular in Rheumatology study. Multivariate models with physical function as the dependent variable (Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire for AS and PsA, respectively) were performed. Independent variables were a proxy for the Charlson Comorbidity Index (CCIp; range 0-27), sociodemographic data, disease activity (erythrocyte sedimentation rate [ESR] and Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] in AS; Disease Activity Score in 28 joints [DAS28] using the ESR in PsA), disease duration, radiographic damage, and treatments. Results were reported as beta coefficients, 95% confidence intervals (95% CIs), and P values.Results. We included 738 patients with AS and 721 with PsA; 21% of patients had >1 comorbidity. Comorbidity burden (CCIp) was independently associated with worse adjusted physical function in patients with PsA (β = 0.11). Also, female sex (β = 0.14), disease duration (β = 0.01), disease activity (DAS28-ESR; β = 0.19), and the use of nonsteroidal antiinflammatory drugs (β = 0.09), glucocorticoids (β = 0.11), and biologics (β = 0.15) were associated with worse function in patients with PsA. A higher education level was associated with less disability (β = -0.14). In patients with AS, age (β = 0.03), disease activity (BASDAI; β = 0.81), radiographic damage (β = 0.61), and the use of biologics (β = 0.51) were independently associated with worse function on multivariate analyses, but CCIp was not.Conclusion. The presence of comorbidities in patients with PsA is independently associated with worse physical function. The detection and control of the comorbidities may yield an integral management of the disease.

EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update

“…These recommendations address non-topical pharmacological treatments with a main focus on musculoskeletal manifestations. As before, the updated recommendations are targeted at various stakeholders, such as (1) experts involved in the care of patients with PsA, particularly rheumatologists and other health professionals (such as rheumatology nurses), but also general practitioners, dermatologists and other specialists; (2) people with PsA who can use these recommendations for information on current therapies, treatment strategies and opportunities; and (3) other stakeholders which include government and hospital officials, patient organisations, regulatory agencies and reimbursement institutions.…”

“…It comprises both musculoskeletal as well as non-musculoskeletal manifestations; the latter particularly include the skin and the nails, but also potentially the gut (inflammatory bowel disease) or the eyes (uveitis). Active chronic PsA also associates with cardiovascular, psychological and metabolic comorbidities, [1][2][3][4][5][6][7] which, together with the musculoskeletal manifestations, impose a significant patient burden with impact on quality of life and also accelerated mortality. [8][9][10] The day-to-day management of patients with PsA includes non-pharmacological as well as pharmacological interventions.…”

Prevalence and impact of comorbidities in axial spondyloarthritis: systematic review and meta-analysis

“…Studies should avoid using weighted indices that have not been validated for their main outcome of interest (e.g. CCI or ECI for functional impairment [ 21 , 44 ]).…”

Switch rates and total cost associated with apremilast and biologics in biologic-naive patients with psoriatic arthritis

“…This is not a limitation unique to MarketScan; information regarding disease activity/severity is unlikely to exist in any claims database. We attempted to mitigate the lack of data on disease activity/severity by matching the cohorts based on proxies for potential disease activity/severity, including the Charlson Comorbidity Index (i.e., studies have shown more comorbidity burden is associated with higher disease activity and worse disability/function [23,24]), pre-index cost, prior treatment experience (nonsteroidal anti-inflammatory drugs, steroids, phototherapy) and presence of psoriasis. Residual confounding after the propensity score matching cannot be ruled out; we could only match apremilast-treated patients with biologic-treated patients and could not match apremilast-treated patients with TNFi-treated patients and with ILi-treated patients separately because the sample size for the latter group was too small.…”