Biedroń Grzegorz, Wilk Mateusz, Nowakowski Jarosław, Kuszmiersz Piotr, Guła Zofia, Strach Magdalena, Brkic Alen, Haugeberg Glenn, Korkosz Mariusz
Department of Rheumatology and Immunology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 31-315, Cracow, Poland.
Department of Rheumatology, Clinical Immunology and Internal Medicine, University Hospital in Cracow, Cracow, Poland.
Clin Rheumatol. 2025 May 7. doi: 10.1007/s10067-025-07452-6.
Comorbidities are frequently present in patients with axial spondyloarthritis (axSpA) and may contribute to poorer health-related outcomes. Patient-reported outcomes (PROs) serve as tools to assess the patient's perspective on the burden of the disease. The study aimed to evaluating the impact of comorbidities on selected PROs in axSpA.
Adult patients diagnosed with axSpA based on ASAS classification criteria were included in this cross-sectional study. Data collected included comorbidities and PROs [Health Assessment Questionnaire (HAQ), Multi-Dimensional Health Assessment Questionnaire (MDHAQ), 36-Item Short Form Health Survey (SF-36), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI)].
In total, 323 participants were included in the study (44.0% female). Multimorbidity and extended multimorbidity were observed in 63.8% and 38.7% of patients, respectively. Extended multimorbidity was associated with higher HAQ (0.5 [0.1-1.0] vs. 0.3 [0.0-0.8], p < 0.01) and MDHAQ scores (0.3 [0.0-0.6] vs. 0.1 [0.0-0.5], p = 0.03). The BASDAI score was higher in patients with three or more comorbidities than in patients with no comorbidities (2.8 [1.7-4.3] vs. 1.9 [0.9-3.6], p < 0.01). The number of comorbidities was associated with higher scores in the mental health (β = 0.20, p < 0.01) and vitality (β = 0.16, p = 0.02) domains of the SF-36 questionnaire.
Multimorbidity was present in almost two-thirds of cases. Extended multimorbidity was associated with poorer physical functioning, HAQ, MDHAQ, and BASDAI scores, whereas multimorbidity was related to better scores in the mental health and vitality domains. The impact of comorbidities on PROs in axSpA should not be overlooked. Key Points • Multimorbidity is frequent among axial spondyloarthritis' patients. • Only extended multimorbidity (presence of two or more additional diseases, excluding axial spondyloarthritis) was found to be associated with poorer results of patient-reported outcomes, in particular these regarding physical functioning. • Multimorbidity might influence positively some domains of quality of life such as mental health or vitality. • The findings included in the study support the belief that in patients with spondyloarthritis comorbidities might impact patient-reported outcomes which are important when assessing disease activity and response to treatment and should not be disregarded.
合并症在轴性脊柱关节炎（axSpA）患者中经常出现，可能导致更差的健康相关结局。患者报告结局（PROs）是评估患者对疾病负担看法的工具。本研究旨在评估合并症对axSpA患者选定的PROs的影响。
本横断面研究纳入了根据ASAS分类标准诊断为axSpA的成年患者。收集的数据包括合并症和PROs[健康评估问卷（HAQ）、多维健康评估问卷（MDHAQ）、36项简短健康调查问卷（SF-36）、巴斯强直性脊柱炎疾病活动指数（BASDAI）和巴斯强直性脊柱炎功能指数（BASFI）]。
本研究共纳入323名参与者（44.0%为女性）。分别有63.8%和38.7%的患者存在多种合并症和复杂合并症。复杂合并症与更高的HAQ（0.5[0.1 - 1.0]对0.3[0.0 - 0.8]，p < 0.01）和MDHAQ评分（0.3[0.0 - 0.6]对0.1[0.0 - 0.5]，p = 0.03）相关。有三种或更多合并症的患者的BASDAI评分高于无合并症的患者（2.8[1.7 - 4.3]对1.9[0.9 - 3.6]，p < 0.01）。合并症的数量与SF-36问卷的心理健康（β = 0.20，p < 0.01）和活力（β = 0.16，p = 0.02）领域的更高评分相关。
近三分之二的病例存在多种合并症。复杂合并症与较差的身体功能、HAQ、MDHAQ和BASDAI评分相关联，而多种合并症与心理健康和活力领域的较好评分相关。合并症对axSpA患者PROs的影响不应被忽视。要点 • 多种合并症在轴性脊柱关节炎患者中很常见。 • 仅发现复杂合并症（存在两种或更多种其他疾病，不包括轴性脊柱关节炎）与患者报告结局的较差结果相关，特别是与身体功能有关的结局。 • 多种合并症可能对生活质量的某些领域产生积极影响，如心理健康或活力。 • 该研究中的发现支持这样一种观点，即对于脊柱关节炎患者，合并症可能会影响患者报告结局，而这些结局在评估疾病活动和治疗反应时很重要，不应被忽视。
