SAT0617 Comorbidity in patients affected by avascular necrosis of the femoral head and impact of coexistent diseases on contralateral joint involvement
Authors: K. Gudkevich, N. Martusevich, A. Murzich
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Avascular necrosis (AN) represents a significant problem of modern rheumatology. The highest incidence of this disease is in able-bodied men. The risk of disability among patients with avascular necrosis of the femoral head (ANFH) is high, especially in case of bilateral process, as AN tends to progress steadily and results in osteoarthritis due to untimely diagnosis. Patients with AN can be affected by other coexistent diseases, that can influence the disease presentation and management. <h3>Objectives</h3> This study aimed to analyse the prevalence and pattern of comorbidities in patients affected by ANFH and to determine if there is a differential pattern of comorbidities in patients with bilateral and unilateral ANFH. <h3>Methods</h3> This was a cross-sectional study, comprising 102 adult patients, aged 48,<sup>38–58</sup> with a diagnosis of ANFH according to Ficat and Arlet criteria. Sociodemographic, anthropometric, clinical parameters of interest were collected from medical records. In order to characterise the burden of coexisting diseases or conditions Charlson Comorbidity Index was calculated. The data obtained were processed with STATISTICA 10.0 using descriptive and nonparametric statistics. <h3>Results</h3> Among a total of 102 patients, a significant prevalence of comorbidities (86,27%) was found. 78,85% of all patients suffered from 2 or more coexistent conditions. The most prevalent comorbidities were: cardiovascular diseases (CVD) (53,92%), including hypertension (50,0%) and cardiosclerosis (34,31%), endocrine and metabolic disorders (66,67%), including hypercholesterolemia (65,70%) and obesity (32,35%), diseases of the digestive system (30,39%), dorsopathies (22,55%). The number of comorbidities was associated with age (ρ=0,42, p&lt;0,001) and body mass index (ρ=0,29, p &lt;0,001). In patients with bilateral (n=44), compared with those affected by unilateral ANFH (n=58), prevalence of younger age (43,5 (36–51) vs. 54,<sup>43–62</sup> p&lt;0,01) and male gender (odds ratio (OR) 2,99 (95% confidence interval (CI) 1,28–6,99), p&lt;0,05) were detected. A history of (CVD) was more frequent in patients with unilateral ANFH (63,79% vs. 40,91%, OR 3,62 (95%CI 1,67–7,88), p &lt;0,05), as well as hypertension (62,07% vs. 34,09%, OR 3,16 (95%CI 1,40–7,17, p &lt;0,01). Patients with unilateral ANFH were more likely to have higher number of comorbidities (3,80<sup>1,17–6,43</sup> vs. 2,89 (0,73–5,05)) and Charlson Comorbidity Index (0,72 (0,43–1,47) vs. 0,52 (0,43–1,87)). <h3>Conclusions</h3> ANFH is associated with high prevalence of comorbidities, especially CVD. CVD, including hypertension, were more likely to be found in patients with unilateral ANFH, as well as higher comorbidity burden. It can be explained by the fact that patients with CVD received treatment according to national guidelines, including antihypertensive drugs, anticoagulants, statins, etc. This indicates that performing secondary prevention of CVD can be important in both CVD and ANFH, as such treatment can influence on intraosseous blood circulation in the contralateral joint. <h3>Reference</h3> [1] Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med2009;7:357–363. <h3>Disclosure of Interest</h3> None declared