Comorbid Conditions in r-axSpA Accelerate Radiographic Progression Over 2 Years

Jul 17, 2024

Photo Credit: Henadzi Pechan

Patients with r-axSpA and two or more comorbid conditions face greater radiographic progression in 2 years than those without comorbidities.

A study revealed that patients with radiographic axial spondyloarthritis (r-axSpA) and two or more comorbid conditions face greater radiographic progression in 2 years than those without comorbidities. Moreover, these patients displayed higher baseline radiographic damage.

Recent research has shown that multiple comorbidities in patients with axSpA are associated with higher disease activity and reduced treatment response. The current study, presented by Sizheng Steven Zhao, DPhil, aimed to explore whether a higher comorbidity burden correlates with increased radiographic progression in patients with r-axSpA.¹

Data was derived from the Australo-Anglo-American Spondyloarthritis Consortium (TASC). Comorbidity burden was quantified by counting 22 common conditions, including cardiovascular diseases (eg, hypertension and heart failure), cancer, osteoporosis, and depression. Radiographs were evaluated using a modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) scoring system.

“We divided the patients at baseline into four groups, those with no, 1, 2, or 3 or more comorbidities”, Dr. Zhao said. Changes in mSASSS over time were related to the comorbidity count at baseline to assess whether change in mSASSS over time differed between groups. Analyses were adjusted for the following baseline covariates: mSASSS, sex, symptom duration, C-reactive protein (CRP), TNF inhibitor use, extra-musculoskeletal manifestations, and smoking status.

The analysis included 1,150 participants, predominantly men (75%), with a mean age of 44 years and a median follow-up of 2 years. Comorbidities were present in 73% of the cohort, with a median of 1 comorbidity per participant.

Radiographic progression (measured by mSASSS) was more pronounced with increasing comorbidity burden. Whereas those with one comorbidity showed no significant change in mSASSS (-0.2 units over 10 years), those with 2 (2.7 units/10 years) and at least three comorbidities (2.3 units/10 years) exhibited significant increases. No single comorbidity drove this association.

Thus, Dr. Zhao concluded that comorbidity burden is independently associated with greater radiographic progression in axSpA. Moreover, comorbidity is also associated with higher baseline radiographic damage. Therefore, patients with a high comorbidity burden may benefit from targeted management. Future research should explore which conditions contribute most to the observed association and elucidate the underlying causal mechanisms.