Assessing the Comorbidity Burden in Antiphospholipid Syndrome vs Rheumatoid Arthritis

antiphospholipid syndrome
The comorbidity burden of APS is comparable to that of RA where prevalence rates of diabetes mellitus, COPD, and neoplasms were similar between both groups.

The comorbidity burden of antiphospholipid syndrome (APS) is comparable to that of rheumatoid arthritis (RA), according to study data published in Rheumatology. Prevalence rates of diabetes mellitus, chronic obstructive pulmonary disease (COPD), and neoplasms were similar between APS and RA groups. Additionally, patients with APS had higher rates of hypertension, stroke, coronary artery disease, osteoporosis, and depression than patients with RA.

There is limited data on comorbidity prevalence in APS and its difference from high comorbidity burden rheumatic diseases. Accordingly, the study researchers aimed to compare multiple comorbidities between APS and RA.

The study enrolled patients with APS from the Greek APS Registry, a multicenter prospective cohort of patients with primary APS (PAPS) or systemic lupus erythematosus (SLE) with APS (SLE-APS). Patients with APS were age- and sex-matched 1:2 with patients from a Greek multicenter RA cohort study. Both the APS Registry and the RA study assessed patient comorbidities, including cardiovascular risk factors and events, osteoporosis, diabetes mellitus, COPD, depression, and neoplasms. Prevalence rates of these comorbidities were compared between APS and RA groups. Multivariable logistic regression was conducted to assess the relative likelihood of each comorbidity in patients with APS vs RA. Regression models were adjusted for age, sex, disease duration, treatment duration, and other potential confounders, depending on the outcome.

A total of 326 patients with APS were age- and sex-matched with 652 patients with RA. The majority of participants (72.7%) were women. Mean age at enrollment was 48.7 ± 13.4 and 48.9 ± 13.5 years in the APS and RA groups, respectively. The 2 patient groups were comparable regarding disease duration, body mass index (BMI), and mean daily corticosteroids dose. Compared to patients with RA, the APS group was significantly more likely to have stroke (20.3% vs 1.4%; odds ratio [OR], 13.8; 95% confidence interval [CI] 6.5-29.1), coronary artery disease (4.9% vs 2.0%; OR, 2.54; 95% CI, 1.21-5.34), hypertension (29.8% vs 20.9%; OR, 1.87; 95% CI, 1.33-2.64), depression (16.3% vs 10.1%; OR, 1.73; 95% CI, 1.16-2.59), and osteoporosis (OR, 20.3% vs 14.1; OR, 1.61; 95% CI, 1.09-2.40). Patients with APS were also more likely to have ever smoked than patients with RA (53.7% vs 40.5%; OR, 1.75; 95% CI, 1.33-2.30). However, rates of hyperlipidemia (24.2% vs 20.7%), obesity (21% vs 19.6 %), diabetes mellitus (5.5% vs 8.9%), and COPD (3.4% vs 2.2%) were comparable between the APS and RA groups (all P >.05). Rates of malignancies were not significantly different between patient groups (APS: 4.3%; RA: 4.1%; P =.979).

In analyses stratified by APS subtype, smoking and stroke were significantly more prevalent in both PAPS and SLE-APS than in RA. Arterial hypertension (34.6% vs 18.5%; OR, 2.88; 95% CI, 1.78-4.65), coronary artery disease [8.5% vs 1.8%; OR, 5.00; 95% CI, 1.89–13.28), and osteoporosis (28.5% vs 15.2%; OR, 2.36; 95% CI, 1.37-4.09) were significantly more prevalent in the SLE-APS cohort compared with the RA cohort. However, rates of these comorbidities were comparable between the PAPS and RA groups. Diabetes was less prevalent with PAPS compared with RA (3.1% vs 9.0%; P =.025). Across both APS subtypes, hyperlipidemia was independently associated with stroke and cardiovascular disease. In patients with SLE-APS only, corticosteroid treatment duration was associated with greater odds of osteoporosis.

As study limitations, investigators noted that analyses were not adjusted for medications other than corticosteroids, given the different treatments used in APS vs RA. Furthermore, data on disease activity were not available.

Future research should examine appropriate means of comorbidity management in patients with APS, particularly those with SLE-APS. “Regular assessment and management of both traditional and disease-related CV risk factors, awareness for mood disorders, screening and management of osteoporosis and consistent efforts for minimization of CS exposure, should be part of routine patient care in APS,” investigators wrote.


Panopoulos S, Thomas K, Georgiopoulos G, et al. Comparable or higher prevalence of comorbidities in antiphospholipid syndrome vs rheumatoid arthritis: a multicenter, case-control study [published online June 29, 2020]. Rheumatology (Oxford). doi: 10.1093/rheumatology/keaa321