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  1. S. Swain1,2,3,
  2. C. Coupland4,
  3. A. Kamps5,
  4. J. Runhaar6,
  5. A. Dell’isola7,
  6. C. Mallen8,
  7. C. F. Kuo9,
  8. M. Doherty10,
  9. D. Prieto-Alhambra11,
  10. M. Englund12,
  11. S. M. A. Bierma-Zeinstra13,
  12. W. Zhang10,
  13. on behalf of ComOA
  1. 1University of Nottingham, Nottingham, United Kingdom
  2. 2University of Oxford, Primary Care Health Sciences, Oxford, United Kingdom
  3. 3Keele University, Medicine, Keele, United Kingdom
  4. 4University of Nottingham, Centre for Academic Primary Care, School of Medicine, Nottingham, United Kingdom
  5. 5Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
  6. 6Erasmus MC University Medical Center, Rotterdam, Netherlands
  7. 7Lund University, Department of Clinical Sciences, Lund, Sweden
  8. 8Keele University, School of Medicine,, Keele, United Kingdom
  9. 9Chang Gung Memorial Hospital, Division of Rheumatology, Allergy and Immunology, Taiwan, Taiwan, Republic of China
  10. 10University of Nottingham, Academic Rheumatology, Nottingham, United Kingdom
  11. 11University of Oxford, NDORMS, Oxford, United Kingdom
  12. 12Lund University, Department of Clinical Sciences, Lund, United Kingdom
  13. 13Erasmus MC University Medical Center, Department of General Practice, Rotterdam, Netherlands


Background: Associations of osteoarthritis (OA) with different comorbidities have gained attention recently. However, there is no literature on the congruency across different large primary care settings.

Objectives: We examined the associations of OA with 61 different comorbidities diagnosed before and after the first diagnosis of OA in four different European primary care settings from the United Kingdom, the Netherlands, Sweden, and Spain. We tested the congruency and incongruency of the findings across these four countries. Congruency was present if the results of all the centres were significant and favoured in one direction.

Methods: The multicentre ComOA study(1) combined case-control and cohort studies for a total of 3,401,616 people aged 18 or above from four countries’ large primary care records in the UK (CPRD GOLD, n= 518,000), Netherlands (IPCI, n=398,143), Sweden (Skane, n=548,681), and Spain (SIDIAP, n=1,936,792). The study population consisted of incident OA cases and age, sex, and practice matched controls without OA. We examined bidirectional association of 61 comorbidities with OA using case-control and cohort methodology, reported as odds ratios (OR) and hazard ratios (HR) and adjusting for other covariates. Pooled proportions with comorbidities, ORs and HRs were estimated using random effect methods.

Results: Four databases had 845,373 OA cases and 2,556,243 controls. Of 61 comorbidities, all centres examined 33 and 8 conditions in both retrospective and prospective analyses, respectively. The percentage of women participants varied from 41.6% in SIDIAP to 64.0% in IPCI. Mean age at the diagnosis of OA was lowest in CPRD GOLD (59.8 years, SD12.8), and highest in IPCI (65.8 years, SD 12.19). In people with OA the pooled prevalence (%) of the top conditions which were higher than matched controls were: chronic back pain (43.8; 95% CI: 33.0-54.8), hypertension (34.3; 95% CI 26.4-42.6), allergy (21.2; 95% CI 10.3-34.6), cataract (16.0; 95%CI 9.6-23.6), vertigo (13.8; 95% CI 13.7-13.9), depression (12.8; 95%CI 8.2-18.6), and diabetes (12.8; 95%CI 9.3-16.8). Of 33 comorbidities studied retrospectively, 10 showed congruent evidence of association with OA across the four countries. The three leading comorbidities before the diagnosis of OA were fibromyalgia (OR 1.93; 95% CI 1.49-2.49), polymyalgia (1.44; 95% CI 1.31-1.58), and chronic back pain (1.42; 95% CI 1.32-1.53). (Figure 1) 32 of 61 comorbidities showed congruent evidence of association prospectively by at least three centres. (Figure 2) The three leading comorbidities developed after the diagnosis of OA were fibromyalgia (HR: 1.42; 95% CI 1.29-1.56), rheumatoid arthritis (HR: 1.27; 95% CI 1.20-1.35), and polymyalgia (HR: 1.24; 95% CI 1.20-1.27). Non-congruent evidence was found for 14 chronic conditions, either retrospectively or prospectively, such as heart failure, diabetes, dementia, and chronic obstructive pulmonary disease (COPD).

Conclusion: OA is associated with a large number of chronic conditions, especially for painful musculoskeletal conditions, across different countries in Europe, despite different population structures and health systems. Further research is needed to establish the causal association.

REFERENCES: [1] Swain S, Kamps A, Runhaar J, et al Comorbidities in osteoarthritis (ComOA): a combined cross-sectional, case–control and cohort study using large electronic health records in four European countries. BMJ Open 2022;12:e052816. doi: 10.1136/bmjopen-2021-052816.

GERD- Gastroesophageal reflux disease; COPD- Chronic obstructive pulmonary diseases. Pooled hazard ratio was calculated using the ‘random effect’ model for conditions having results from three or more centres.

Figure 1.

Associations between comorbidities and OA before the diagnosis of OA in UK, Netherlands, Sweden and Spain

Figure 2.

Associations between OA and comorbidities after the diagnosis of OA in UK, Netherlands, Sweden and Spain.

Acknowledgements: We thank the Patient Research Participants (PRP) members Jenny Cockshull, Stevie Vanhegan, and Irene Pitsillidou for their involvement since the beginning of the project. We would like to thank the FOREUM for financially supporting the research. Financial disclosure- This work was supported by Foundation for Research in Rheumatology (FOREUM) grant (2019-2022), The Swedish Research Council (2020-01103), Governmental funding of clinical research within the national health services (ALF), and The Swedish Rheumatism Association. CM is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands and the National Institute for Health Research (NIHR) School for Primary Care.

Disclosure of Interests: Subhashisa Swain: None declared, Carol Coupland: None declared, Anne Kamps: None declared, Jos Runhaar: None declared, Andrea Dell’Isola: None declared, Christian Mallen: None declared, Chang-Fu Kuo: None declared, Michael Doherty: None declared, Daniel Prieto-Alhambra Prof. Prieto-Alhambra’s research group has received grant support from Amgen, Chesi-Taylor, Novartis, and UCB Biopharma. His department has received advisory or consultancy fees from Amgen, Astellas, AstraZeneca, Johnson, and Johnson, and UCB Biopharma and fees for speaker services from Amgen and UCB Biopharma., Martin Englund: None declared, S.M.A. Bierma-Zeinstra: None declared, Weiya Zhang: None declared.

  • Epidemiology
  • Public health
  • Comorbidities
  • Observational studies/ registry

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