Men and women with spondyloarthritis (SpA) had different prevalences of comorbidities, and these comorbidities had different effects on disease outcomes in both men and women, according to research published today. Rheumatism and Musculoskeletal Diseases Open.

Although data on sex differences in SpA are available, studies on the differential impact of comorbidities between men and women are limited. Therefore, researchers conducted a post hoc analysis of the COMOrbidities in SpondyloArthritis (COMOSPA) study to describe and compare the prevalence and impact of comorbidities between men and women with SpA.

The original COMOSPA study included adult patients with SpA who completed various questionnaires assessing disease activity, quality of life, and physical function. These include the Bass Ankylosing Spondylitis Disease Activity Index (BASDAI), the Ankylosing Spondylitis Disease Activity Score by C-reactive Protein (ASDAS-CRP), the Bass Ankylosing Spondylitis Functional Index (BASFI), and the European health-related quality of life (EQ5D) score.

Various comorbidities were evaluated, including cardiovascular disease, osteoporosis, neoplasms, infections, and fibromyalgia.

A total of 3982 patients diagnosed with SpA were included in the final analysis, of whom 65% were male and 35% female, with a mean age of 43.6 years.

Analysis of comorbidities showed a significantly higher prevalence of renal impairment in men (2.9% vs. 1.4%; P =.005) and ischemic heart disease (3.3% vs. 1.5%; P =.001) compared to women. Conversely, women were more likely to have a high waist circumference (48.1% vs. 22.3%; P <.001) and fibromyalgia (19.6% vs. 10.3%; P <.001).

After adjusting for age and use of biological disease-modifying antirheumatic drugs, men were associated with a higher risk of cardiovascular disease and its associated risk factors, including hypertension (odds ratio) compared with women [OR], 1.47; 95% CI, 1.23-1.77), dyslipidemia (OR, 1.29; 95% CI, 1.07-1.56), renal dysfunction (OR, 2.36; 95% CI, 1.46-4.01), ischemic heart disease (OR, 2.77; 95% CI, 1.72-4.65). These associations were consistent even when the analysis was restricted to patients aged 55 years and older. Furthermore, men with SpA were less likely to suffer from fibromyalgia compared to women (OR, 0.47; 95% CI, 0.39-0.57).

Comorbidities have been shown to significantly influence disease activity in SpA patients, with fibromyalgia showing the strongest association with increased BASDAI scores (4.50 increase), followed by vasculitis (1.63 increase); Chronic obstructive pulmonary disease (1.16 increase), ischemic heart disease (1.12 increase). Most comorbidities were significantly associated with high BASDAI scores, but dyslipidemia, hepatitis B virus, hepatitis C virus, history of neoplasms, vertebral fractures, diverticulitis, and amyloidosis were not. It was.

Associations between disease activity and the ASDAS-CRP index reflected similar trends, although generally weaker associations. Effect sizes ranged from 0.20 for myocardial infarction to 1.50 for fibromyalgia.

The influence of comorbidities on disease activity differed by gender. For example, high waist circumference and peptic ulcer disease have a more pronounced impact on disease activity in women, while fibromyalgia and osteoporosis have a greater impact on men. These sex-specific differences were evident in BASDAI and ASDAS-CRP scores, although some associations did not reach statistical significance.

According to the physical function analysis, BASFI scores were significantly lower than those with fibromyalgia (increase of 3.92), chronic obstructive pulmonary disease (increase of 1.78), vasculitis (increase of 1.58), and history of serious infections (increase of 1.00). It was higher in patients with comorbidities. .

Results were similar for quality of life analysis based on EQ5D scores.

The COMOSPA study did not include specific criteria to identify the presence of fibromyalgia, which was cited as a limitation. Furthermore, the data come from a cross-sectional analysis, which prevents the formation of causal relationships.

The study authors said, “Our study highlights the importance of employing the ASDAS-CRP when comorbidities are present, as it helps to alleviate gender differences in disease assessment.” concluded.