FRI0326 PREVALENCE AND IMPACT OF COMORBIDITIES IN AXIAL SPONDYLOARTHRITIS: SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: S. S. Zhao, S. Robertson, T. Reich, N. L. Harrison, R. J. Moots, N. Goodson
Journal: Annals of the Rheumatic Diseases (2020)

Background: Comorbidities are common among patients with axial spondyloarthritis (axSpA). The majority of axSpA patients have at least one comorbid medical condition in addition to any extra-articular manifestations [1]. Comorbidity ‘burden’ is associate with poorer function, quality of life and work-related outcomes [2]. They also influence treatment decisions and are key drivers of mortality. Objectives: We performed a systematic review and meta-analysis to 1) describe the prevalence of commonly reported comorbidities, 2) compare the prevalence of comorbidities between axSpA and control populations. Methods: A systematic review was performed in September 2019 using Medline, PubMed, Scopus and Web of Science, in accordance with PRISMA guidelines. Studies were included if they reported the prevalence of comorbidities on disease outcomes, and excluded if they focused on a single comorbidity or closely related diseases in one organ system. Two independent reviewers screened titles and abstracts, assessed full-texts for eligibility and extracted data from qualifying studies. Where possible, we performed meta-analyses for comorbidities reported by at least 3 studies using random-effects models. Pooled prevalence estimates were reported as percentages (95% confidence interval, I 2 statistic for heterogeneity). Results: 36 studies reported prevalence of of individual comorbidities, amounting to a combined sample size of 119,427 patients. The most prevalent individual comorbidities were hypertension (pooled prevalence 22%), hyperlipidaemia (17%) and obesity (14%) (Figure 1). Eleven studies consistently showed higher prevalence of comorbidities in axSpA than controls (Table 1); odds ratios (OR) were particularly large for depression (pooled OR 1.80) and congestive cardiac failure (OR 1.84). There was significant heterogeneity for the majority of meta-analysis estimates. Table 1. Meta-analysis estimates for odds ratios (OR) of comorbidities compared between axSpA and control groups. Number of studies Pooled OR 95% confidence interval I 2 , % Hypertension 9 1.58 1.29 to 1.92 98 Any cardiovascular disease 3 1.42 0.999 to 2.03 99 Any ischaemic heart disease 7 1.51 1.21 to 1.87 87 Congestive cardiac failure 4 1.84 1.25 to 2.73 89 Stroke 6 1.30 1.04 to 1.62 81 Peripheral vascular disease 5 1.47 1.10 to 1.96 83 Diabetes 8 1.14 1.001 to 1.30 83 Hyperlipidaemia 5 1.18 1.01 to 1.39 94 Cancer 5 1.22 1.01 to 1.47 93 Depression 4 1.80 1.45 to 2.23 92 Figure 1. Pooled prevalence of individual comorbidities. Conclusion: Comorbidities are common in axSpA. Almost all comorbidities examined were more prevalent in axSpA patients than age and sex matched controls, with ≥80% higher odds for congestive cardiac failure and depression. Systematic and repeated assessments should therefore be integrated into routine clinical practice to ensure holistic patient-centred management. Additional studies are needed to validate comorbidities indices for axSpA research. References: [1]Zhao SS, Radner H, Siebert S, et al. Comorbidity burden in axial spondyloarthritis: a cluster analysis. Rheumatology. 2019 Oct 1;58(10):1746–54. [2]Nikiphorou E, Ramiro S, van der Heijde D, et al. Association of Comorbidities in Spondyloarthritis With Poor Function, Work Disability, and Quality of Life: Results From the Assessment of SpondyloArthritis International Society Comorbidities in Spondyloarthritis Study. Arthritis Care Res. 2018 Aug;70(8):1257–62. Disclosure of Interests: None declared