Background Increased risk of cardio-vascular disease, and osteoporosis is documented in SpA. Some of these co-morbidities (e.g. cardiovascular disease risk) are subject to recommendations, with specific components relevant to rheumatic inflammatory diseases (e.g. yearly evaluation of BP, LDL-cholesterol). However, it is known that a gap exists between recommendations and their implementation in practice.
Objectives To evaluate: 1) the prevalence of SpA co-morbidities and risk factors for these comorbidities in different countries worldwide, 2) the gap between available recommendations and daily practice concerning prevention/management of these co-morbidities and 3) the number of risk factors detected due to the present initiative
Methods International, cross-sectional study of consecutive SpA patients in routine care. Data comprise SpA characteristics, plus relevant cardiovascular, infection, cancer, osteoporosis and gastro-intestinal disorders.
Results Twenty-two participating countries (from 4 continents) included 3984 patients. Age: 44±14 years, disease duration 8±9 years, male gender: 65%, past or current axial (89%) and articular peripheral (56%) involvement; ASDAS-CRP: 2.0±1.1, BASFI 3.2±2.7, NSAID intake during last 3 months 68% and any past or current intake of methotrexate (33%), sulfasalazine (44%) or biologicals (44%).
The most frequent diseases (past or current) found were osteoporosis (13%), gastro-duodenal ulcus (11%), cardiovascular events (myocardial infarction or stroke) (4%), solid cancers (3%), and hepatitis B infection (3%). The most frequent risk factors for these diseases were hypertension (34%), smoking (current or past (<3years)) 29%, dyslipidaemia (27%) and family history of cardiovascular disease and breast cancer (each 15%). Substantial inter-country variability was observed for the screening of co-morbidities (e.g. LDL-cholesterol measured at least in the last year from 8% (Taiwan) to 98% (Germany) or dentist visit in the last year from 0% (China) to 85% (Netherlands)). Evaluation of comorbidities and risk factors as part of this study unveiled previously undetected abnormalities [e.g. elevated blood pressure (14%), hyperglycemia (4%)] and emphasized the sub-optimal management of co-morbidities.
Conclusions This study suggests a) a high prevalence of co-morbidities in SpA, b) a substantial inter-country variability c) a highly variable detection of relevant risk factors. This study strongly suggests that rigorous application of systematic evaluation of co-morbidities may permit earlier detection, which ultimately may result in an improved outcome of patients with SpA.
Acknowledgements Study was conducted under the umbrella of ASAS and financially supported by unrestricted grants from Abbvie, Pfizer and UCB.
Disclosure of Interest None declared
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