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Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study
  1. Anna Moltó1,2,
  2. Adrien Etcheto1,2,
  3. Désirée van der Heijde3,
  4. Robert Landewé4,
  5. Filip van den Bosch5,
  6. Wilson Bautista Molano6,
  7. Ruben Burgos-Vargas7,
  8. Peter P Cheung8,
  9. Eduardo Collantes-Estevez9,
  10. Atul Deodhar10,
  11. Bassel El-Zorkany11,
  12. Shandor Erdes12,
  13. Jieruo Gu13,
  14. Najia Hajjaj-Hassouni14,15,
  15. Uta Kiltz16,
  16. Tae-Hwan Kim17,
  17. Mitsumasa Kishimoto18,
  18. Shue-Fen Luo19,
  19. Pedro M Machado20,21,
  20. Walter P Maksymowych22,
  21. José Maldonado-Cocco23,
  22. Helena Marzo-Ortega24,
  23. Carlo-Maurizio Montecucco25,
  24. Salih Ozgoçmen26,
  25. Floris van Gaalen3,
  26. Maxime Dougados1,2
    1. 1Rheumatology B Department, Paris Descartes University, Cochin Hospital, AP-HP, Paris, France
    2. 2INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
    3. 3Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
    4. 4ARC, Amsterdam & Atrium MC Heerlen, Amsterdam, The Netherlands
    5. 5Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
    6. 6Rheumatology Department, Faculty of Medicine, HMC/UMNG, Bogota, Colombia
    7. 7Servicio de Reumatologia, Hospital General de México and Universidad Nacional Autonoma de México, México City, Mexico
    8. 8Division of Rheumatology, National University Hospital, Singapore, Singapore
    9. 9Rheumatology Department, Reina Sofia Hospital; Maimonides Institute for Biomedical Research of Cordoba/University of Cordoba, Cordoba, Spain
    10. 10Div Arthritis/Rheumatic Diseases (OPO9), Oregon Health and Science University, Portland, USA
    11. 11Department of Rheumatology, Cairo University, Cairo, Egypt
    12. 12Russian Academy of Sciences, Moscow, Russia
    13. 13Division of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guanzhou, China
    14. 14Department of Rheumatology, Mohamed Vth University, URAC 30, El Ayachi Hospital, Salé, Morocco
    15. 15Faculty of Medicine and Pharmacy, Rabat, Morocco
    16. 16Rheumazentrum Ruhrgebiet, Herne, Germany
    17. 17Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
    18. 18Immuno-Rheumatology Center, St Luke's International Hospital, St Luke's International University, Tokyo, Japan
    19. 19Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan
    20. 20Department of Rheumatology, University of Coimbra, Coimbra, Portugal
    21. 21University College London, London, UK
    22. 22Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
    23. 23Rheumatology Section, Instituto de Rehabilitacion Psicofisica and Argentine Rheumatologic Foundation “Dr Osvaldo Carcia Morteo”, Buenos Aires, Argentina
    24. 24NIHR-Leeds Musculoskeletal Biomedical research Unit, Leeds Institute of Molecular Medicina, University of Leeds, Leeds, UK
    25. 25Univerity of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
    26. 26Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Erciyes University, Gevher Nesibe Hospital, Kayseri, Turkey
    1. Correspondence to Dr Anna Moltó, Rheumatology B Department, Paris Descartes University, Cochin Hospital, 27 rue du Fabourg Saint Jacques, Paris 75014, France; anna.molto{at}


    Background Increased risk of some comorbidities has been reported in spondyloarthritis (SpA). Recommendations for detection/management of some of these comorbidities have been proposed, and it is known that a gap exists between these and their implementation in practice.

    Objective To evaluate (1) the prevalence of comorbidities and risk factors in different countries worldwide, (2) the gap between available recommendations and daily practice for management of these comorbidities and (3) the prevalence of previously unknown risk factors detected as a result of the present initiative.

    Methods Cross-sectional international study with 22 participating countries (from four continents), including 3984 patients with SpA according to the rheumatologist.

    Statistical analysis The prevalence of comorbidities (cardiovascular, infection, cancer, osteoporosis and gastrointestinal) and risk factors; percentage of patients optimally monitored for comorbidities according to available recommendations and percentage of patients for whom a risk factor was detected due to this study.

    Results The most frequent comorbidities were osteoporosis (13%) and gastroduodenal ulcer (11%). The most frequent risk factors were hypertension (34%), smoking (29%) and hypercholesterolaemia (27%). Substantial intercountry variability was observed for screening of comorbidities (eg, for LDL cholesterol measurement: from 8% (Taiwan) to 98% (Germany)). Systematic evaluation (eg, blood pressure (BP), cholesterol) during this study unveiled previously unknown risk factors (eg, elevated BP (14%)), emphasising the suboptimal monitoring of comorbidities.

    Conclusions A high prevalence of comorbidities in SpA has been shown. Rigorous application of systematic evaluation of comorbidities may permit earlier detection, which may ultimately result in an improved outcome of patients with SpA.

    • Spondyloarthritis
    • Epidemiology
    • Cardiovascular Disease
    • Osteoporosis
    • Infections

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