Ab0978 the Burden of Comorbidities on Spondyloarthritis Management: A Monocentric Cohort Study

Background: Spondyloarthritis (SpA) patients are often affected by comorbidities due to shared risk factors, chronic inflammation, and its treatment. Despite the availability of multiple therapeutic agents, it is not uncommon to face difficulties in reaching complete remission and the therapeutic approach for patients that do not respond adequately relies on multiple pharmacological shifts/swaps or on add-on management strategies. The presence of comorbidities could complicate the therapeutic choice in SpA 1-7, thus compromising disease control and patients' quality of life (QoL). Objectives: The purpose of our study was to describe the comorbidities' prevalence in a monocentric cohort of SpA patients, evaluating their possible impact on therapeutic strategies. Methods: This cross-sectional monocentric study included patients followed in the SpA out-patients clinic of our Rheumatology Unit from April 2022 to November 2023. Adults patients with a diagnosis of Psoriatic Arthritis (PsA) and Axial Spondyloarthritis (AxSpA) according to CASPAR and ASAS criteria respectively were enrolled. Clinical and epidemiological data, as well as the pharmacological history, were obtained from the medical charts. Taking into account the definition of a "difficult to treat" rheumatoid arthritis, we defined as "multi-failure" those patients who were treated with more than 3 disease modifying anti-rheumatic drugs (DMARDs); accordingly, we analyzed the pharmacological history to underline the frequency of therapeutic shifts/swaps for both conventional synthetic (cs), biologic (b) and targeted (ts) DMARDs. Univariate and multivariate analyses were done to evaluate correlations between SpA patients' comorbidities (type and number) and therapeutic changes. Results: We enrolled 273 patients. Demographic and clinical features are summarized in Table 1. In Table 2 we reported the prevalence and the number of observed comorbidities. The most common comorbidities were osteoarthritis (24.5%), cardiovascular disease (17.9%), and osteoporosis (16.1%), with at least one cardiovascular risk factor in 78.4% of the patients. Multi-failure patients exhibited a higher prevalence of cardiovascular disease (p=0.004), obesity (p=0.03), osteoarthritis (p=0.005) and psychiatric disorders (p=0.02) (Tab 2). Moreover, multi-failure patients had a significantly higher risk of presenting at least one cardiovascular (CV) risk factor (p=0.0006) and an aggregation of at least 3 comorbidities (p=0.02). Conclusion: The distribution of comorbidities in our cohort was comparable to those described in the Literature7, with a predominance of CV risk factors. Multi-failure patients seemed to have a worst comorbidities' burden. In particular, they exhibit a higher prevalence of CV risk factors, as well as osteoarthritis and psychiatric disorders. These data underline comorbidities could complicate the therapeutic management of SpA patients, with a higher probability to need a shift or swap strategy. Therefore, a holistic patient-centred approach and a systematic screening for comorbidities should be applied in SpA patients, to identify those at higher risk of therapeutic failures, thus optimizing their quality of care. REFERENCES: 1 Fakih O, Desmarets M, Martin B, Prati C, Monnet E, Verhoeven F, Wendling D. RMD Open 2023;9(4):e003461. PMID: 37996127. 2 Hou X, Lee YH, Qian T, Chen C, Tam LS. Int J Rheum Dis 2023;26(7):1222-1224. PMID: 37394891; 3 Kumthekar A, Ashrafi M, Deodhar A. Clin Rheumatol 2023;42(9):2251-2265. PMID: 37097525 4 López-Medina C, Molto A. RMD Open 2020;6(2):e001135. PMID: 32892168. 5 Panagiotopoulos A, Fragoulis GE. Clin Ther 2023;45(2):177-189. PMID: 36737317. 6 Scriffignano S, Perrotta FM, De Socio A, Lubrano E. Clin Rheumatol 2019;38(1):3-10. PMID: 30338414. 7 Zhao SS, Robertson S, Reich T, Harrison NL, Moots RJ, Goodson NJ. Rheumatology 2020;59(Supplement 4):iv47–iv57 Table 2: Comorbidities Acknowledgements: NIL. Disclosure of Interests: None declared.