Fernández-Carballido Cristina, Martín-Martínez María A, García-Gómez Carmen, Castañeda Santos, González-Juanatey Carlos, Sánchez-Alonso Fernando, García de Vicuña Rosario, Erausquin-Arruabarrena Celia, López-Longo Javier, Sánchez María D, Corrales Alfonso, Quesada-Masachs Estefanía, Chamizo Eugenio, Barbadillo Carmen, Bachiller-Corral Javier, Cobo-Ibañez Tatiana, Turrión Ana, Giner Emilio, Llorca Javier, González-Gay Miguel A
Hospital Universitario San Juan de Alicante, Alicante, Spain.
Sociedad Española de Reumatología, Madrid, Spain.
Arthritis Care Res (Hoboken). 2020 Jun;72(6):822-828. doi: 10.1002/acr.23910. Epub 2020 May 14.
To evaluate the impact of comorbidities on physical function in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA).
This was a cross-sectional analysis of the baseline visit from the Cardiovascular in Rheumatology study. Multivariate models with physical function as the dependent variable (Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire for AS and PsA, respectively) were performed. Independent variables were a proxy for the Charlson Comorbidity Index (CCIp; range 0-27), sociodemographic data, disease activity (erythrocyte sedimentation rate [ESR] and Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] in AS; Disease Activity Score in 28 joints [DAS28] using the ESR in PsA), disease duration, radiographic damage, and treatments. Results were reported as beta coefficients, 95% confidence intervals (95% CIs), and P values.
We included 738 patients with AS and 721 with PsA; 21% of patients had >1 comorbidity. Comorbidity burden (CCIp) was independently associated with worse adjusted physical function in patients with PsA (β = 0.11). Also, female sex (β = 0.14), disease duration (β = 0.01), disease activity (DAS28-ESR; β = 0.19), and the use of nonsteroidal antiinflammatory drugs (β = 0.09), glucocorticoids (β = 0.11), and biologics (β = 0.15) were associated with worse function in patients with PsA. A higher education level was associated with less disability (β = -0.14). In patients with AS, age (β = 0.03), disease activity (BASDAI; β = 0.81), radiographic damage (β = 0.61), and the use of biologics (β = 0.51) were independently associated with worse function on multivariate analyses, but CCIp was not.
The presence of comorbidities in patients with PsA is independently associated with worse physical function. The detection and control of the comorbidities may yield an integral management of the disease.
评估合并症对强直性脊柱炎（AS）和银屑病关节炎（PsA）患者身体功能的影响。
这是一项对风湿病心血管研究基线访视的横断面分析。以身体功能作为因变量（分别为AS的巴氏强直性脊柱炎功能指数和健康评估问卷以及PsA的健康评估问卷）进行多变量模型分析。自变量为查尔森合并症指数替代指标（CCIp；范围0 - 27）、社会人口统计学数据、疾病活动度（AS中的红细胞沉降率[ESR]和巴氏强直性脊柱炎疾病活动指数[BASDAI]；PsA中使用ESR的28个关节疾病活动评分[DAS28]）、疾病持续时间、影像学损伤和治疗情况。结果以β系数、95%置信区间（95% CIs）和P值报告。
我们纳入了738例AS患者和721例PsA患者；21%的患者有1种以上合并症。合并症负担（CCIp）与PsA患者经调整后的较差身体功能独立相关（β = 0.11）。此外，女性（β = 0.14）、疾病持续时间（β = 0.01）、疾病活动度（DAS28 - ESR；β = 0.19）以及使用非甾体类抗炎药（β = 0.09）、糖皮质激素（β = 0.11）和生物制剂（β = 0.15）与PsA患者较差的功能相关。较高的教育水平与较低的残疾程度相关（β = -0.14）。在AS患者中，年龄（β = 0.03）、疾病活动度（BASDAI；β = 0.81）、影像学损伤（β = 0.61）和使用生物制剂（β = 0.51）在多变量分析中与较差的功能独立相关，但CCIp并非如此。
PsA患者合并症的存在与较差的身体功能独立相关。合并症的检测和控制可能有助于疾病的综合管理。
