Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada.
J Rheumatol. 2013 Aug;40(8):1349-56. doi: 10.3899/jrheum.121500. Epub 2013 Jun 15.
To assess the added effect of comorbidity on quality of life (QOL) in psoriatic arthritis (PsA).
Between 2006 and 2012, 631 patients were recruited from the University of Toronto PsA Clinic. Using the clinical database, we ascertained the frequency of 15 comorbidities. The Medical Outcomes Study Short Form-36 (SF-36) physical (PCS) and mental component (MCS) summary scales were used to assess QOL. Linear regression analyses were conducted to estimate the magnitude of the association between number and type of comorbidities and PCS and MCS scores, after adjustment for disease-related and sociodemographic variables.
Prevalence of comorbidity was high, with 42% of patients having 3 or more comorbid conditions. After adjustment for inflammatory disease-related and sociodemographic factors, a history of 3 or more comorbid conditions accounted for only 2% and 1% of the R(2) value explained in PCS and MCS scores, respectively. In terms of added burden, type of comorbid condition was more significant than number of comorbidities. After adjustment for disease-related and sociodemographic factors, fibromyalgia (FM), neurological disorders, and obesity jointly accounted for 6% of R(2) value explained in PCS scores, while FM and depression/anxiety jointly accounted for about 9% of the R(2) explained in MCS scores. The point decrease in PCS and MCS scores associated with each of these disorders was clinically significant. The 11 other comorbid conditions failed to achieve statistical significance in the models.
The added effect of comorbidity on patient-reported physical and mental health in PsA was more related to type of comorbidity than number of comorbidities.
评估合并症对银屑病关节炎（PsA）患者生活质量（QOL）的附加影响。
2006 年至 2012 年间，我们从多伦多大学 PsA 诊所招募了 631 名患者。我们使用临床数据库确定了 15 种合并症的发生频率。采用医疗结局研究简表 36 项（SF-36）的身体成分（PCS）和精神成分（MCS）综合评分来评估 QOL。在调整疾病相关和社会人口统计学变量后，我们进行线性回归分析，以评估合并症的数量和类型与 PCS 和 MCS 评分之间的关联程度。
合并症的患病率较高，42%的患者有 3 种或更多种合并症。在调整炎症性疾病相关和社会人口统计学因素后，3 种或更多种合并症仅分别占 PCS 和 MCS 评分中解释 R²值的 2%和 1%。就额外负担而言，合并症的类型比数量更为重要。在调整疾病相关和社会人口统计学因素后，纤维肌痛（FM）、神经障碍和肥胖症共同解释了 PCS 评分中解释 R²值的 6%，而 FM 和抑郁/焦虑症共同解释了 MCS 评分中解释 R²值的约 9%。与这些疾病相关的 PCS 和 MCS 评分每下降一点都具有临床意义。其余 11 种合并症在模型中未达到统计学意义。
在 PsA 患者中，合并症对患者报告的身体和心理健康的附加影响更多与合并症的类型有关，而不是数量。
