Background/Purpose: Data on the prevalence of comorbidities and their association with disease activity and functional impairment in axial spondyloarthritis (axSpA) are scarce. The aim of this study was to investigate the prevalence of comorbidities and to analyse their association with disease activity and functional impairment in a large population-based cohort of patients with axSpA.

Methods: A stratified random sample of patients with axSpA (ICD-10 M45) was drawn from health insurance data in Germany. Patients in the sample received a survey on demographic, socioeconomic, and disease-related parameters including disease activity (assessed using BASDAI) and functional impairment (assessed using BASFI).

Survey data were linked to health insurance data gathering additional information on comorbidities and drug prescriptions. Comorbidities were based on Elixhauser coding algorithms (excluding rheumatic diseases and augmented upon osteoporosis).

The prevalence of comorbidities in axSpA patients was compared to a sex- and age-matched control group of patients without axSpA drawn from health insurance data.

Separate multivariable linear regression models were calculated to determine the association of comorbidities with disease activity and functional impairment.

Results: A total of 1,776 patients with axSpA were included in the analyses. The patients’ main characteristics are shown in Table 1: The mean age was 56.1 years and 46.4% were female. The most prevalent comorbidities are illustrated in Figure: 52% of the patients presented with hypertension, 25% with depression, and 23% with chronic pulmonary disease. The prevalence of the majority of comorbidities was higher in axSpA as compared to controls. Results from the multivariable linear regression models are presented in Table 2 showing that the number of comorbidities was significantly associated with both disease activity and functional impairment: each comorbidity was associated with BASDAI increase by 0.11 and BASFI increase by 0.10 points independently of other factors including treatment.

Conclusion: Comorbidities are common in axSpA patients and are independently associated with higher disease activity and higher level of functional impairment. Higher disease activity and a higher level of functional disability might be indicators of a severe disease resulting in the development of comorbid conditions.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-comorbidities-with-disease-activity-and-functional-impairment-in-axial-spondyloarthritis-results-from-a-nationwide-population-based-study/