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22-05-2019 | Rheumatology | News | Article

Comorbidities linked to worse physical function in psoriatic arthritis patients

medwireNews: Psoriatic arthritis (PsA) patients with multiple comorbidities have worse physical function than those with just one comorbidity, according to a cross-sectional analysis of the CARMA study of patients from daily clinical practice in Spain.

Overall, 21.4% of the 721 PsA patients included in the study by Miguel González-Gay (Hospital Universitario Marqués de Valdecilla, Santander, Spain) and colleagues had more than one comorbidity (indicated by a proxy for the Charlson Comorbidity Index [CCIp] score >1), while the remaining 78.6% patients had just one comorbidity (CCIp=1).

And among the PsA patients, those with a greater number of comorbidities had significantly worse physical function than those with just one comorbidity, as shown by a median HAQ score of 0.75 versus 0.25.

In contrast, although similar proportions of patients with ankylosing spondylitis (AS) were also found to have multiple comorbidities versus just one, at 20.7% and 79.3%, there were no significant differences in physical function among AS patients in the two groups (BASFI= 3.3 and 3.0, respectively).

Similarly, there was an independent association between comorbidity burden and physical function in patients with PsA, but not those with AS, in a multivariate model adjusted for various confounding factors. In the PsA group, increases in CCIp were significantly associated with higher disability (correlation coefficient [β]=0.11).

Significant associations were also found between worse physical function and female sex (β=0.14), longer disease duration (β=0.01), higher disease activity (β=0.19), and use of nonsteroidal anti-inflammatory drugs (β=0.09), biologic DMARDs (β=0.15), and glucocorticoids (β=0.11).

“Interestingly, a higher educational level was associated with less disability” in PsA patients, write González-Gay and colleagues in Arthritis Care & Research.

They note: “The association between higher educational level and lower reported disability identified in our patients with PsA has already been reported in patients with SpA [spondyloarthritis].

“The fact that the educational level can influence the way in which the patients handle, or report, their disease process cannot be dismissed.”

Overall, “the presence of comorbidities may decrease the reported [physical function] of patients with SpA,” say the researchers.

“The detection and control of the comorbidities may yield an integral management of the disease,” they conclude.

By Catherine Booth

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Arthritis Care Res 2019; doi:10.1002/acr.23910​​​​​​​