Importance of Type vs Number of Comorbidities in Psoriatic Arthritis

Type, rather than number, of comorbidities, has a greater effect on the quality of life of patients with psoriatic arthritis (PsA), according to research published in the Journal of Rheumatology.

Researchers examined the relationship between comorbidities and quality of life among patients with PsA. Data that included information on patient comorbidities were extracted from 3 participating centers in France.. Participants included in the analysis met the Classification Criteria for Psoriatic Arthritis. In total, 124 patients (62.1% men; nearly 100% Caucasian) were included in the analysis; mean age was 52.6±12.6 years, and mean disease duration was 11.3±9.6 years.

Nearly 55% of participants had a Disease Activity Score in 28 Joints with C-reactive protein (DAS28-CRP) score of 2.6 or lower; mean DAS28-CRP was 2.7±1.1. The number of comorbid conditions present was 2.0±1.3 (range 0-6); 30.6% of the patient population had a current or past history of 3 or more comorbidities.

The most frequent comorbidities included anxiety (44.4%), overweight (41.1%), hypertension (34.7%), depression (29.0%), obesity (29.0%), [AW1] dyslipidemia (26.6%), diabetes mellitus (12.9%), and osteoporosis (11.3%). Prevalence of myocardial infarction and stroke in the population was 8.1% and 7.3%, respectively, while prevalence of asthma and chronic obstructive pulmonary disorder was 7.3% and 2.4%, respectively

Results of a univariate linear regression analysis indicated that 5 comorbid conditions (cardiovascular disease, anxiety, depression, respiratory disease, and cancer) were significantly associated with lower levels of mental health (P <.05). Anxiety and depression demonstrated the strongest associations, based on R² values (R²=28.7% and 12.4%, respectively).

No significant association between physical health and any comorbidity was noted. In a multivariate linear regression analysis examining the effect of mental health on comorbid conditions, the researchers found that anxiety was strongly associated with level of mental health, accounting for 19.4% of the variance in mental health scores (β=-10.81; R²=0.194; P <.0001).

Study limitations included the cross-sectional nature of the study, potential inaccuracies in comorbidity data, and limitations presented by the use of the DAS28-CRP, which is not typically used for psoriatic arthritis.

The researchers of the study concluded, “The impact of psychological distress on quality of life needs further attention and is of importance, since anxiety is frequently seen in PsA and may be treatable. As such, screening for anxiety, rating its severity, and managing anxiety symptoms could lead to better quality of life in patients with PsA.”

Reference

Bavière W, Deprez X, Houvenagel E, et al. Associations between comorbidities and quality of life in psoriatic arthritis: Results from a multicentric cross-sectional study (PSAQUAL study) [published online June 15, 2019]. J Rheumatol. doi: 10.3899/jrheum.181471

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