Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
People with psoriatic arthritis (PsA) have an increased risk for several comorbidities that negatively impact quality of life and survival. Defining the relationships between comorbidities and PsA characteristics may help identify subsets of PsA patients at high risk for comorbidities. The objective of this study was to determine if PsA severity or duration associated with the number of comorbidities.
Methods
This was a cross-sectional study of PsA participants in the Utah Psoriasis Initiative Arthritis Registry. Data were collected with questionnaires, interviews, and examinations between 1/22/2010 and 4/21/2014. Disease severity measures included a functional assessment [BASFI], a quality of life instrument [Psoriatic Arthritis Quality of Life (PsAQOL)], and disease activity measures, [68 tender joint count (TJC), 66 swollen joint count (SJC), BASDAI, Physician Global, Patient Global, and a cutaneous physician global assessment multiplied by the body surface area (PGAxBSA)]. To analyze PsA duration, a proportional odds logistic regression model was used to test for an association between PsA duration (<5 years, 5-15 years, and >15 years) and number of comorbidities (0, 1-2, or ≥3 comorbidities), after adjustment for age, gender, race, body mass index (BMI), TJC, and SJC. For severity assessments, a general linear model was used to test for differences in the mean score for each instrument after adjusting for age, gender, race, BMI, and PsA duration.
Results
PsA was diagnosed and phenotyped by a rheumatologist in 190 participants (Table 1). Compared to participants with PsA duration <5 years, participants with durations of 5-15 years and >15 years had higher mean numbers of comorbidities, but the difference was statistically significant only in the group with duration of 5-15 years (Table 2). The number of comorbidities was associated with BASFI (Table 3), but not with measures of quality of life or disease activity (data not shown).
Conclusion
Higher numbers of comorbidities may be associated with longer PsA duration and functional limitations as measured by BASFI. Anticipated analysis of a larger number of participants in a multi-center comorbidity project will provide a better understanding of the relationships between comorbidities, PsA duration, and PsA severity.
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Table 1. Demographics, disease characteristics, and comorbidities (n=170-190) |
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|
Number of participants (%) or mean (SD) |
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|
PsA duration |
<5 years |
5-15 years |
>15 years |
|
Number |
76 |
55 |
58 |
|
Demographics |
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|
Age, yrs |
46.0 (12.3) |
49.0 (14.0) |
54.7 (12.8) |
|
Female |
43 (56.6) |
27 (49.1) |
30 (51.7) |
|
Caucasian Race |
71 (93.4) |
54 (98.2) |
55 (94.8) |
|
BMI > 30 |
30.3 (8.7) |
30.5 (8.8) |
30.4 (8.9) |
|
Disease severity |
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|
BASFI |
3.7 (2.6) |
4.8 (2.7) |
4.3 (2.7) |
|
BASDAI |
5.3 (2.2) |
6.0 (2.4) |
4.7 (2.1) |
|
PsAQOL |
7.0 (5.6) |
11.1 (9.0) |
6.6 (5.8) |
|
Tender joint count |
3.4(4.3) |
4.2 (5.3) |
3.7 (6.0) |
|
Swollen joint count |
2.8(3.3) |
4.6 (7.3) |
2.9 (5.5) |
|
PGAxBSA |
5.5 (10.0) |
14.7 (52.2) |
5.0 (13.1) |
|
Physician Global |
3.8 (1.5) |
4.3 (1.9) |
3.4 (1.8) |
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Comorbidities |
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Number of comorbidities |
1.8 (2.0) |
2.7 (2.0) |
2.6 (2.1) |
|
Uveitis |
2 (2.6) |
0 |
4 (6.9) |
|
Inflammatory Bowel Disease |
0 |
2 (3.6) |
5 (8.6) |
|
Hypertension |
18 (23.7) |
25 (45.5) |
21 (36.2) |
|
Myocardial Infarction |
2 (2.6) |
1 (1.8) |
1 (1.7) |
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Congestive Heart Failure |
3 (3.9) |
3 (5.5) |
0 |
|
Angina |
1 (1.3) |
2 (3.6) |
2 (3.4) |
|
Stroke |
3 (3.9) |
2 (3.6) |
2 (3.4) |
|
Dyslipidemia |
13 (17.1) |
17 (30.9) |
20 (34.5) |
|
Chronic kidney disease |
2 (2.6) |
4 (7.3) |
2 (3.4) |
|
COPD/emphysema |
1 (1.3) |
0 |
3 (5.2) |
|
Cancer |
5 (6.6) |
1 (1.8) |
6 (10.3) |
|
Diabetes |
5 (6.6) |
7 (12.7) |
11 (19.0) |
|
Osteoporosis/osteopenia |
5 (6.6) |
8 (14.5) |
7 (12.1) |
|
Seizure disorder |
1 (1.3) |
1 (1.8) |
0 |
|
Multiple sclerosis |
0 |
0 |
2 (3.4) |
|
Restless leg syndrome |
5 (6.6) |
2(3.6) |
7 (12.1) |
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Insomnia |
6 (7.9) |
10 (18.2) |
7 (12.1) |
|
Sleep apnea |
12 (15.8) |
11 (20.0) |
14 (24.1) |
|
Chronic heartburn/reflux |
13 (17.1) |
14 (25.5) |
15 (25.9) |
|
Thyroid disease |
8 (10.5) |
7 (12.7) |
8 (13.8) |
|
Hepatitis B |
1 (1.3) |
2 (3.6) |
0 |
|
Hepatitis C |
1 (1.3) |
3 (5.5) |
0 |
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Depression |
17 (22.4) |
18 (32.7) |
12 (20.7) |
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Table 2. Number of comorbidities and PsA duration (n=190) |
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|
Duration(years) |
n |
Unadjusted OR (95% CI) |
p value before adjustment |
Adjusted* OR (95% CI) |
p value after adjustment |
|
<5 |
76 |
Reference |
Reference |
Reference |
Reference |
|
5-15 |
55 |
2.54 (1.36-4.73) |
0.003 |
2.63 (1.29-5.36) |
0.008 |
|
>15 |
58 |
2.39 (1.30-4.42] |
0.003 |
1.73 (0.86-3.48) |
0.128 |
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* Adjusted for age, gender, race, body mass index, tender joint count, & swollen joint count |
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Table 3. Number of comorbidities and BASFI (n=170) |
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Number of comorbidities |
n |
BASFI LS* mean (95% Confidence Limits) |
p value (Compared to ≥5 comorbidities) |
|
0 |
47 |
2.33 (0.46-4.29) |
0.04 |
|
1 |
34 |
2.51 (0.57-4.46) |
0.10 |
|
2 |
31 |
2.18 (0.32-4.14) |
0.03 |
|
3 |
27 |
3.84 (1.83-5.85) |
0.99 |
|
4 |
21 |
4.20 (2.11-6.30) |
1.00 |
|
≥5 |
29 |
4.26 (2.42-6.11) |
Reference |
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LS = least squares |
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Disclosure:
S. Tanner,
None;
M. McFadden,
None;
D. Clegg,
None;
J. Walsh,
None.
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