POS0946 DISTRIBUTION OF COMORBIDITIES IN SPONDYLOARTHRITIS WITH REGARD TO THE PHENOTYPE AND THE PRESENCE OF PSORIASIS: DATA FROM THE ASAS-COMOSPA STUDY
Authors: Puche Larrubia M. Á. , Ladehesa Pineda M. L. , Pilar F. U. , Moltó A. , López-Medina C. , Collantes-Estevez E. 
Published: May 2021

Background:

Comorbidities have been reported to be more prevalent in patients with Spondyloarthritis (SpA) compared to the general population. Previous studies have suggested that patients with peripheral phenotypes exhibit a higher prevalence of traditional cardiovascular risk (CV) factors compared to those with a predominantly axial phenotype. However, the role of psoriasis in such differences has not been deeply studied.

Objectives:

To compare the prevalence of comorbidities (CV, malignancies and osteoporosis (vertebral or peripheral fracture, or low bone mineral density)) between patients with axial and peripheral phenotypes and to evaluate the role of psoriasis in such comorbidities in the whole spectrum of SpA (including psoriatic arthritis).

Methods:

Patients from the cross-sectional ASAS-COMOSPA study were classified as having either axial (presence of sacroiliitis on x-ray or MRI) or peripheral phenotype (absence of sacroiliitis AND presence of arthritis, enthesitis or dactylitis). Patients with each phenotype were divided into two groups depending on the presence or history of psoriasis. Pair-wise comparisons among the four groups (axial and peripheral with psoriasis/without psoriasis phenotypes) were conducted through univariate logistic regressions and generalized linear mixed models using disease duration and country as fixed and random effects, respectively. Multivariate analysis using were used to evaluate whether psoriasis and the phenotype are independently associated with each comorbidity.

Results:

A total of 3291 patients were included in this analysis (mean age 43.6 years, 65% males). The peripheral phenotype with psoriasis showed the highest prevalence of hypertension (44.9%), dyslipidaemia (34%) and diabetes (8.8%), while axial phenotype without psoriasis exhibited the lowest prevalence of dyslipidaemia (14.2%), diabetes (4.1%) and stroke (0.9%) (Table 1). Among patients with psoriasis, the axial phenotype showed a significantly [OR, 95%CI] lower prevalence of hypertension [OR 0.5, 0.4-0.8] and lower Framingham score [OR 0.97, 0.95-0.99] compared to peripheral patients even after adjusting for disease duration and country. Among patients with axial phenotype, patients with psoriasis showed higher prevalence of hypertension [OR 1.8, 1.4-2.2], dyslipidaemia [OR 2.0, 1.7-2.5], diabetes [OR 2.1, 1.4-3.0] and Framingham score [OR 1.0, 1.0-1.1] than non-psoriatic patients. Multivariate analysis confirmed that hypertension, dyslipidaemia and the Framingham score are independently associated with both the psoriasis and the peripheral phenotype.

Prostatic cancer and colon cancer were independently associated with the presence of psoriasis but not with the phenotype. No differences were found across groups concerning osteoporosis.

Conclusion:

Both a peripheral phenotype and the presence of psoriasis were independently associated with an increased CV risk. Psoriasis seems to be associated with a higher prevalence of some malignant diseases, while osteoporosis do not seem to be associated with either phenotype or the presence of cutaneous involvement.

Table 1.

Description of comorbidities across the four groups.

Psoriatic axial
N = 460
n (%)Non-psoriatic axial
N = 2541
n (%)Psoriatic peripheral
N = 147
n (%)Non-psoriatic peripheral
N = 136
n (%)p-value*BMI, mean (SD)27.4 (5.5)25.5 (5.5)27.3 (5.7)26.6 (5.3)<0.001Hypertension135 (29.5)487 (19.2)66 (44.9)25 (18.4)<0.001Dyslipidemia113 (24.8)359 (14.2)50 (34)23 (17)<0.001Diabetes37 (8.1)104 (4.1)13 (8.8)7 (5.2)<0.001Ischemic heart disease16 (3.5)51 (2)5 (3.4)2 (1.5)0.162Stroke11 (2.4)22 (0.9)3 (2)2 (1.5)0.028Framingham score, mean (SD)9.6 (8.7)6.6 (7.5)11.8 (8.8)5.8 (6)<0.001Prostatic cancer5 (1.8)5 (0.3)0 (0)0 (0)0.006Breast cancer (1.7)3 (0.4)1 (1.4)0 (0)0.181Colon cancer4 (0.9)4 (0.2)1 (0.7)1 (0.7)0.046Basal cell carcinoma6 (1.3)9 (0.4)1 (0.7)4 (3)<0.001Lymphoma0 (0)4 (0.2)3 (2)0 (0)<0.001

*ANOVA or chi-square for continuous and qualitative variables, respectively.

Acknowledgements:

This study was conducted under the umbrella of the International Society for Spondyloarthritis Assessment (ASAS).

Disclosure of Interests:

None declared