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

Abstract

Objectives Comorbidities are common in people with axial spondyloarthritis (axSpA). In this systematic review and meta-analysis, we aimed to: (i) describe the prevalence of commonly reported comorbidities, (ii) compare comorbidities between axSpA and control populations, and (iii) examine the impact of comorbidity burden on axSpA outcomes. Methods We systematically searched Medline, PubMed, Scopus and Web of Science using a predefined protocol in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We excluded studies of only one comorbid condition or a few closely related diseases within one organ system. Where possible, meta-analysis was performed using random-effects models. Results A total of 40 studies were included for analysis. 36 studies reported prevalence of comorbidities, amounting to a combined sample size of 119 427 patients. The number of comorbidities studied ranged from 3 to 43. The most prevalent individual comorbidities were hypertension (pooled prevalence 23%), hyperlipidaemia (17%) and obesity (14%). Eleven studies consistently showed higher prevalence of comorbidities in axSpA than controls, particularly large differences were seen for depression [pooled odds ratio (OR) 1.80] and heart failure (OR 1.84). Comorbidities (total number of and individual conditions) were also associated with axSpA disease activity, functional impairment, quality of life, work productivity and mortality. Conclusions Comorbidities are common in axSpA, particularly cardiovascular diseases and risk factors. Most comorbidities were more prevalent in axSpA patients than in control populations. Overall comorbidity burden, and many individual conditions, were associated with axSpA outcomes including worse disease severity, work productivity and mortality.

The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis

“…The pooled prevalence estimate for MI of 2.8% is comparable to 3.1% in rheumatoid arthritis [ 35 ], 3.2% in psoriatic arthritis [ 36 ] and 2.2% in axial spondyloarthritis [ 37 ]. There is an increased risk of MI compared to non-gout controls.…”

Comorbidities in psoriatic arthritis: a systematic review and meta-analysis

“…The top five most prevalent comorbidities—hypertension (34%), metabolic syndrome (29%), obesity (27%), hyperlipidaemia (24%) and overall cardiovascular diseases (CVD; 19%)—provide an interesting comparison against comorbidity patterns in axSpA (another member of the SpA family). In a similar review of comorbidities in axSpA [ 24 ], the commonest comorbidities were similar but differed in prevalence (hypertension (23%), infections (18%), hyperlipidaemia (17%), obesity (14%) and CVD (12%)). For example, obesity was nearly twice more common in PsA than axSpA.…”

“…Together, these findings highlight the need for better CVD risk assessment and stratification in PsA and other chronic rheumatic diseases, to prevent or reduce cardiovascular morbidity and mortality. Interestingly, despite differences in cardiometabolic risk factors, the prevalence of cardiovascular diseases was similar between PsA and axSpA: any CVD 19 vs. 12%; angina 3.6 vs. 3.6%; myocardial infarction 3.2 vs. 2.2%; heart failure 1.3 vs. 1.8%; stroke 2.8 vs. 1.8%; peripheral vascular disease 1.6 vs. 1.1%, respectively [ 24 ].…”

Efficacy and safety of warm acupuncture in the treatment of ankylosing spondylitis

“…AS refers to an autoimmune disease, early performance for joint pain and morning stiffness, late will appear joint deformation and other symptoms, to the patient and his family brought a heavy burden. [ 6 , 7 ] Drug therapy is currently considered the main effective treatment for AS, [ 16 , 25 , 26 ] whereas it can cause various side effects; some drugs are expensive, which cannot be afforded generally. [ 17 , 20 – 22 , 27 ] As a traditional therapy, warm acupuncture and moxibustion has been extensively used in clinical practice for its advantages (eg, safety, no obvious adverse reactions, and low price).…”

“…[ 5 , 6 ] More importantly, AS has been suggested to increase the risk of certain diseases (eg, cardiovascular diseases, respiratory diseases, digestive diseases, and reproductive diseases). [ 7 – 11 ] As revealed from recent studies, patients with autoimmune diseases have a higher risk of COVID-19. [ 12 ] Thus, the treatment of AS is of high clinical and public health significance.…”