Identifying comorbidities in axial spondyloarthritis patients

The prevalence of comorbidities in axial spondyloarthritis (AxSpA) populations is high and impacts on many facets of the patient’s disease process, as well as impacting on their response to treatment, the Irish Society for Rheumatology (ISR) 2022 Spring Meeting heard. The meeting took place on 19-20 May in the Sligo Park Hotel. 

Dr Nicola Goodson, Consultant Rheumatologist at Liverpool University Hospital, and Senior Lecturer in Rheumatology, University of Liverpool, UK, presenting via video, discussed ‘Comorbidities in Axial Spondyloarthritis’, a chronic, inflammatory disease, which mainly affects the spine and pelvic joints. 

“The most important thing really is to identify comorbidities in axial spondyloarthritis patients,” said Dr Goodson. 

“Try and be a little more holistic in assessment of our patients with chronic inflammatory conditions.” 

A 2020 study, published in the Arthritis Research and Therapy journal, highlighted the various comorbid conditions in patients with AxSpA compared to a population without the condition. 

“Whilst the comorbidities [in this study] are the common comorbid conditions that we see in the general population, including hypertension, dyslipidaemia, and obesity, there was also increased prevalence of conditions such as depression and osteoporosis associated with axial spondyloarthritis,” Dr Goodson explained. 

AxSpA can present very early in life, and can dramatically impact a person’s quality-of-life. It is particularly associated with depression, so rheumatologists have a responsibility to look for depression in these patients, she said. 

In the cited study, hypertension was 14 per cent higher in patients with AxSpA, chronic pulmonary disease was 13 per cent higher, and depression was present in about one-in-four AxSpA patients, compared to 17 per cent of non-AxSpA, Dr Goodson noted. 

An important take-home from this talk is to recognise that depression is a common comorbidity amongst our AxSpA patients 

“An important take-home from this talk is to recognise that depression is a common comorbidity amongst our AxSpA patients, but it may not be recognised by the treating clinicians,” she said. “It does appear to be associated with worse disease activity and functional impairment. 

“Where possible, offer treatment and support for patients who are affected by this comorbidity. With the hope that if we can help manage their inflammatory disease, as well as guide their treatment towards better management of their depression and anxiety, then we have a much better outcome in the long-term.” 

Osteoporosis is also important to remember “as a comorbid condition associated with all of our inflammatory rheumatic diseases, particularly our axial spondyloarthritis patients”, Dr Goodson also told the meeting. 

“There are particular problems with ankylosing spondylitis, where new bone formation can lead to a very rigid spine, [and] with associated osteoporosis puts patients at risk of life-changing fractures.” 

Bone density can usually be measured with DEXA imaging, however, DEXA imaging of the spine can lead to inaccurate results in AxSpA. DEXA scans of the hip are recommended instead, according to Dr Goodson, as are quantitative CT (QCT) and high-resolution peripheral quantitative CT tests, or the recently developed trabecular bone score. The trabecular bone score “basically is a computer algorithm that allows a pixelated view of the vertebral body” and shows holes in trabecular bone density. The lower the score, the lower the bone density, and the higher the increased fracture risk. 

Irish Society for Rheumatology, Spring Meeting, Sligo Park Hotel, 19-20 May 2022.