Background Psoriasis and Psoariatic arthritis (PsA) are chronic inflammatory diseases associated with other health concerns such as obesity, type II diabetes, dyslipidemia, hypertension and cardiovascular diseases. This association can be due to chronic inflammatory process which activates many signaling pathways leading to metabolic disturbances or because of the shared genes among these diseases. The role of these metabolic factors in the pathogenesis, severity and diagnosis of PsA and Psoriasis is unclear.
Objectives To identify association of comorbidities with PsA and compare it to other types of spondyloarthritis (SpA). Also to look for any variation in these comorbidities within the groups depending on age, gender, education, type of treatment, disease duration and severity
Methods The patient database at the Rheumatology Department of University Hospitals Leuven was used, which contains demographic, radiological, medical and laboratory information of 518 patients with PsA and other types of SpA. The basic demographic data were analysed and patients were grouped into PsA and SpA depending on their diagnosis. Each group was seperately analysed on the basis of gender, age, education, workstatus, treatment, type and number of comorbidities and later on compared with each other. The data was statistically analysed by chi square test, t-test and Fisher exact test.
Results Out of 518 patients in the database 62.74% were males and 37.25% females. 53.66% of all the patients were also found to have comorbidities. The PsA group contained 262 patients with age ranging from 21-79 years (Mean=58.8, Median=55, SD±12.03) whereas the SpA group had 256 patients with age ranging from 19-77 years (Mean=44.91, Median=44, SD±12.89). The difference in the mean age of 2 groups was statistically significant (p<0.01). The PsA group was found to have more comborbidities as compared to SpA group (p <0.05). In addition patients in the PsA group were more likely to have multiple comorbidities as compared to the patients in the SpA group who more often showed a single comorbidity pattern (p<0.05). Among all the comorbidities the largest burden was found to be cardiovascular in both the groups. Tthe cardiovascular disease burden was significantly higher in the PsA group as compared to SpA (p<0.05). Similarly we also found an increase in metabolic disease burden (including diabetes, hyperlipidemia, gout and hyperuricemia) in the PsA group (p<0.01). Among all individual cardiovascular and metabolic comorbidities coronary artery disease and hyperlipidemia showed a marked difference between the 2 groups (p<0.05) A large number of patients(15.85%) in PsA group met the criteria for metabolic syndrome, which was again different from SpA group (p<0.05). Of interest an increase incidenced of malignancy in PsA group as compared to SpA was found (p<0.05). There was no relationship between the type of medication and comorbidity in the 2 groups and no significant difference was seen between patients treated with TNF blockers or DMARDS (p>0.05).
Conclusions There is a significant increase in comorbidities and malignancy in patients with PsA as compared to SpA, irrespective of demographic factors and type of treatment. The cause for this increase is not known and further research to understand the epidemiological and molecular causes hereof is necessary.
Disclosure of Interest None Declared
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