Leiden University Medical Center, Leiden, The Netherlands, and King's College London, London, UK.
Leiden University Medical Center, Leiden, The Netherlands.
Arthritis Care Res (Hoboken). 2018 Aug;70(8):1257-1262. doi: 10.1002/acr.23468. Epub 2018 Jun 28.
Comorbidities add to the burden of disease and its complexity, and may prevent the achievement of treat-to-target goals. The objective of this study was to study the relationship between comorbidities and key disease outcomes in spondyloarthritis (SpA), namely function, work ability, and quality of life.
Patients from the multinational (22 countries), cross-sectional Assessment in SpondyloArthritis international Society (ASAS) Comorbidities in Spondyloarthritis study were included in the analysis, provided they fulfilled the ASAS criteria. Data on comorbidities based on both self- and physician-report were collected through questionnaires and were subsequently used to compute the Rheumatic Disease Comorbidity Index (RDCI). Univariable and multivariable (adjusted for relevant confounders) multilevel (with country as a random effect) linear or logistic (as appropriate) regression analyses were conducted to investigate the relationship between the RDCI and functional ability, work ability, and quality of life.
In total, 3,370 of 3,984 recruited patients (85%) fulfilled the ASAS criteria: 66% were male, mean ± SD age was 43 ± 14 years, mean ± SD disease duration was 8.4 ± 9.5 years, and mean ± SD RDCI was 0.7 ± 1.1. At least 1 comorbidity was reported in 51% of patients; 9% had ≥3 comorbidities. RDCI was independently associated with a higher Bath Ankylosing Spondylitis Functional Index score (β = 0.37, 95% confidence interval [95% CI] 0.30, 0.43), lower EuroQol 5-domain questionnaire (β = -0.03, 95% CI -0.04, -0.02), less work employment (odds ratio [OR] 0.83, 95% CI 0.76, 0.91), higher absenteeism (OR 1.18, 95% CI 1.04, 1.34), and higher presenteeism (OR 1.42, 95% CI 1.26, 1.61).
Comorbidities in SpA adversely influence physical function, work ability, and quality of life and are important to take into account in daily clinical practice.
合并症增加了疾病的负担和复杂性，并可能阻碍达到治疗目标。本研究的目的是研究强直性脊柱炎（SpA）中的合并症与关键疾病结局之间的关系，即功能、工作能力和生活质量。
该分析纳入了来自多国（22 个国家）、横断面评估强直性脊柱炎国际学会（ASAS）合并症研究的符合 ASAS 标准的患者。通过问卷收集基于患者自身和医生报告的合并症数据，并随后用于计算风湿病合并症指数（RDCI）。采用单变量和多变量（调整相关混杂因素）多水平（以国家为随机效应）线性或逻辑（视情况而定）回归分析，研究 RDCI 与功能能力、工作能力和生活质量之间的关系。
共纳入 3984 名符合 ASAS 标准的患者中的 3370 名（85%）：66%为男性，平均年龄为 43±14 岁，平均病程为 8.4±9.5 年，平均 RDCI 为 0.7±1.1。51%的患者报告至少有一种合并症；9%的患者有≥3 种合并症。RDCI 与更高的 Bath 强直性脊柱炎功能指数评分独立相关（β=0.37，95%置信区间[95%CI]0.30，0.43）、更低的 EuroQol 5 维度问卷评分（β=-0.03，95%CI-0.04，-0.02）、更少的工作就业（比值比[OR]0.83，95%CI0.76，0.91）、更高的缺勤率（OR1.18，95%CI1.04，1.34）和更高的在职率（OR1.42，95%CI1.26，1.61）。
SpA 中的合并症对身体功能、工作能力和生活质量产生不利影响，在日常临床实践中需要考虑到这些因素。
