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- Title
Comorbidity burden in axial spondyloarthritis: a cluster analysis.
- Authors
Zhao, Sizheng Steven; Radner, Helga; Siebert, Stefan; Duffield, Stephen J; Thong, Daniel; Hughes, David M; Moots, Robert J; Solomon, Daniel H; Goodson, Nicola J
- 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.
- Subjects
UNITED Kingdom; AGE distribution; ANKYLOSING spondylitis; ANXIETY; CLUSTER analysis (Statistics); CONFIDENCE intervals; CORONARY disease; MENTAL depression; FIBROMYALGIA; HYPERTENSION; IRRITABLE colon; MULTIVARIATE analysis; NONSTEROIDAL anti-inflammatory agents; HEALTH outcome assessment; QUALITY of life; QUESTIONNAIRES; SEX distribution; SMOKING; WORLD health; COMORBIDITY; BODY mass index; CROSS-sectional method; DISEASE duration
- Publication
Rheumatology, 2019, Vol 58, Issue 10, p1746
- ISSN
1462-0324
- Publication type
Article
- DOI
10.1093/rheumatology/kez119