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Meta-Analysis
. 2020 Oct 1;59(Suppl4):iv47-iv57.
doi: 10.1093/rheumatology/keaa246.

Prevalence and impact of comorbidities in axial spondyloarthritis: systematic review and meta-analysis

Sizheng Steven Zhao  1   2 , Selina Robertson  3 , Tzvi Reich  3 , Nicolas L Harrison  2 , Robert J Moots  1   2 , Nicola J Goodson  1   2
Affiliations
Meta-Analysis

Prevalence and impact of comorbidities in axial spondyloarthritis: systematic review and meta-analysis

Sizheng Steven Zhao et al. Rheumatology (Oxford). .

Abstract

Objectives: Comorbidities are common in people with axial spondyloarthritis (axSpA). In this systematic review and meta-analysis, we aimed to: (i) describe the prevalence of commonly reported comorbidities, (ii) compare comorbidities between axSpA and control populations, and (iii) examine the impact of comorbidity burden on axSpA outcomes.

Methods: We systematically searched Medline, PubMed, Scopus and Web of Science using a predefined protocol in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We excluded studies of only one comorbid condition or a few closely related diseases within one organ system. Where possible, meta-analysis was performed using random-effects models.

Results: A total of 40 studies were included for analysis. 36 studies reported prevalence of comorbidities, amounting to a combined sample size of 119 427 patients. The number of comorbidities studied ranged from 3 to 43. The most prevalent individual comorbidities were hypertension (pooled prevalence 23%), hyperlipidaemia (17%) and obesity (14%). Eleven studies consistently showed higher prevalence of comorbidities in axSpA than controls, particularly large differences were seen for depression [pooled odds ratio (OR) 1.80] and heart failure (OR 1.84). Comorbidities (total number of and individual conditions) were also associated with axSpA disease activity, functional impairment, quality of life, work productivity and mortality.

Conclusions: Comorbidities are common in axSpA, particularly cardiovascular diseases and risk factors. Most comorbidities were more prevalent in axSpA patients than in control populations. Overall comorbidity burden, and many individual conditions, were associated with axSpA outcomes including worse disease severity, work productivity and mortality.

Keywords: Ankylosing spondylitis; axial spondyloarthritis; comorbidity; meta-analysis; multimorbidity; systematic review.

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Figures

<sc>Fig</sc>. 1
Fig. 1
Pooled prevalence of individual comorb conditions reported by ≥3 studies
<sc>Fig</sc>. 2
Fig. 2
Summary of meta-analysis estimates for odds ratios comparing comorbidities between axSpA and control groups
See this image and copyright information in PMC

References

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