[Combined comorbid pathology in axial spondyloarthritis].

AIM: To analyze the frequency of combined comorbid pathology and its effect on clinical and instrumental characteristics in axial spondyloarthritis (SpA), including axial psoriatic arthritis.

MATERIALS AND

METHODS

222 patients were included in the study: 108 with axial SpA, 114 with axial psoriatic arthritis. The average age was 40.9±12.4 years, and the duration of inflammatory back pain was 68±53.3 months. A standard rheumatological examination, X-ray of the cervical and lumbar spine, and pelvis were performed. The activity of spondylitis was determined by BASDAI and ASDAS-CRP. The patients were divided into 3 groups: 1st - without comorbid diseases (CD) - 66 (29.7%) patients, 2nd - with 1-2 CD - 78 (35.1%), 3rd - with ≥3 CD - 78 (35.1%).

RESULTS

The patients in 3rd group were older than in the other groups (in 1st group - 39±12.1 years, in 2nd - 39±11.2, in 3rd - 44.5±13.1; p1-3=0.039, p2-3=0.028), they had a higher level of Pain (in the 1st - 54.3±19.7 mm VAS, in the 2nd - 51.1±22.7, in the 3rd - 63.3±19.4; p=0.01 for all comparisons), the ASDAS-CRP value was higher than in the 1st group (in the 1st - 2.2±1.1, in the 2nd - 2.6±1.1, 3rd - 2.7±0.9; p1-3=0.01), syndesmophytes were more common in the cervical and/or lumbar spine, ankylosis of the faceted joints in the cervical spine (p< 0.05). The results of the cluster analysis allowed us to group the features into 4 main clusters. The first cluster, in which the ASDAS-CRP and BASDAI indices were grouped, is combined, on the one hand, with a cluster with the presence of psoriasis, comorbidity (≥3), and structural changes in the spine, on the other hand, with other CD and extra-skeletal manifestations of SpA.

CONCLUSION

The presence of a combination of CD was associated with higher activity of spondylitis, more common structural injuries of the spine. The choice of therapy, taking into account СD and extra-skeletal manifestations of SpA, should improve patient treatment outcomes.