Comorbidity burden in axial spondyloarthritis: a cluster analysis

Zhao, S. S., Radner, H., Siebert, S. , Duffield, S. J., Thong, D., Hughes, D. M., Moots, R. J., Solomon, D. H. and Goodson, N. J. (2019) Comorbidity burden in axial spondyloarthritis: a cluster analysis. Rheumatology, 58(10), pp. 1746-1754. (doi: 10.1093/rheumatology/kez119) (PMID:31220322)

Abstract

Objectives: To examine how comorbidities cluster in axial spondyloarthritis (axSpA) and whether these clusters are associated with quality of life, global health and other outcome measures. Methods: We conducted a cross-sectional study of consecutive patients meeting ASAS criteria for axSpA in Liverpool, UK. Outcome measures included quality of life (EQ5D), global health and disease activity (BASDAI). We used hierarchical cluster analysis to group patients according to 38 pre-specified comorbidities. In multivariable linear models, the associations between distinct comorbidity clusters and each outcome measure were compared, using axSpA patients with no comorbidities as the reference group. Analyses were adjusted for age, gender, symptom duration, BMI, deprivation, NSAID-use and smoking. Results: We studied 419 patients (69% male, mean age 46 years). 255 patients (61%) had at least one comorbidity, among whom the median number was 1 (range 1–6). Common comorbidities were hypertension (19%) and depression (16%). Of 15 clusters identified, the most prevalent clusters were hypertension-coronary heart disease and depression-anxiety. Compared with patients with no comorbidities, the fibromyalgia-irritable bowel syndrome cluster was associated with adverse patient-reported outcome measures; these patients reported 1.5-unit poorer global health (95%CI 0.01, 2.9), reduced quality of life (0.25-unit lower EQ5D; 95%CI −0.37, −0.12) and 1.8-unit higher BASDAI (95% CI 0.4, 3.3). Similar effect estimates were found for patients in the depression-anxiety cluster. Conclusion: Comorbidity is common among axSpA patients. The two most common comorbidities were hypertension and depression. Patients in the depression-anxiety and fibromyalgia-IBS clusters reported poorer health and increased axSpA severity.

• Item Type: Articles
• Additional Information: S.Z. was supported by awards from the Royal College of Physicians (John Glyn bursary) and Royal Society of Medicine (Kovacs fellowship). D.H.S. was supported by grants from the National Institute of Health (NIH-P30-AR072577 (VERITY) and NIH-K24AR055989).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Siebert, Professor Stefan
• Authors: Zhao, S. S., Radner, H., Siebert, S., Duffield, S. J., Thong, D., Hughes, D. M., Moots, R. J., Solomon, D. H., and Goodson, N. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Research Centre: College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
• Journal Name: Rheumatology
• Publisher: Oxford University Press
• ISSN: 1462-0332
• ISSN (Online): 1462-0332
• Published Online: 09 April 2019