A newly developed method of evaluating the impact of different comorbidities in patients with psoriatic Arthritis (PsA) can be used to prospectively identify those PsA patients at greater risk of hospitalisation and premature death.
Psoriasis arthritis (PSA) is associated with multiple comorbidities, including metabolic syndrome (hyperlipidaemia, hypertension, diabetes mellitus, and obesity), other autoimmune diseases (e.g. inflammatory bowel disease), and lymphoma.
“To date, no disease-specific models have been developed to identify those comorbidities with the greatest impact on PsA patient´s health status,” said Yasser El Miedany of the Department of Rheumatology, Darent Valley Hospital (Great Britain). Such a PsA-comorbidity index will enable clinicians to prospectively include comorbidities assessment and management in their standard practice.
El Miedany and his colleagues assessed the impact of different comorbidities in a retrospective multicentre analysis of 1,707 PsA patients, monitored over a 10-year period, on predicting future death and hospitalisation. To develop a morbidity index score, different cut-off values were identified to delineate patients at different stages of risk of hospitalisation and death.
Those PsA patients who had a higher incidence of comorbid conditions and were at higher risk of hospitalisation were men, with older age at disease onset, and a high BMI at baseline (p < 0.05). The most prevalent comorbidities strongly associated with a 10-year risk of death or hospitalisation in PsA patients were: cardiovascular (seven different comorbidities), osteoporosis, falls, depression/anxiety, diabetes mellitus, renal and liver diseases, lung and GI problems, as well as infection (p < 0.001).
A Multidimensional Disease Relapse (MDR) score as an independent predictor of disease status, based on 5 different indicators of disease activity, namely the Disease Activity Index for Psoriatic Arthritis (DAPSA), Psoriasis Area and Severity Index (PASI), Functional disability score, enthesitis and erythrocyte sedimentation rate/C – reactive protein, was shown to be significantly associated with the 10-year risk of death or hospitalisation (p=0.002). Male gender, cardiovascular disease, evidence of a risk of falls, diabetes, infection, anxiety, and this MDR score were all significant independent factors affecting the outcome of the disease at 10 years. In addition, this new score outperformed the Charlson Comorbidity Index (CCI), which is most commonly used to assess comorbidities.
“The PsA-comorbidity index is a valid method for estimating risk of death in PsA patients. By making PsACI available to rheumatologists worldwide, we hope it will prove an effective guide to optimising the management of Psoriatic Arthritis,” Dr Yasser El Miedany concluded.
He suggested that this new tool should be included as part of the patient-reported outcome measures used in standard clinical practice.
Source: El Miedany Y et al. Psoriatic arthritis comorbidity index: development and validation of a new specific tool for classifying prognostic comorbidity in psoriatic arthritis patients. Abstract OP0091, presented on the 11th of June 2016
2016 Annual EULAR Meeting