Background: Increased risk of some comorbidities has been reported in spondyloarthritis (SpA). Recommendations for detection/management of some of these comorbidities have been proposed, and it is known that a gap exists between these and their implementation in practice.

Objective: To evaluate (1) the prevalence of comorbidities and risk factors in different countries worldwide, (2) the gap between available recommendations and daily practice for management of these comorbidities and (3) the prevalence of previously unknown risk factors detected as a result of the present initiative.

Methods: Cross-sectional international study with 22 participating countries (from four continents), including 3984 patients with SpA according to the rheumatologist. The prevalence of comorbidities (cardiovascular, infection, cancer, osteoporosis and gastrointestinal) and risk factors; percentage of patients optimally monitored for comorbidities according to available recommendations and percentage of patients for whom a risk factor was detected due to this study.

Results: The most frequent comorbidities were osteoporosis (13%) and gastroduodenal ulcer (11%). The most frequent risk factors were hypertension (34%), smoking (29%) and hypercholesterolaemia (27%). Substantial intercountry variability was observed for screening of comorbidities (e.g., for LDL cholesterol measurement: from 8% (Taiwan) to 98% (Germany)). Systematic evaluation (e.g., blood pressure (BP), cholesterol) during this study unveiled previously unknown risk factors (e.g., elevated BP (14%)), emphasising the suboptimal monitoring of comorbidities.

Conclusions: A high prevalence of comorbidities in SpA has been shown. Rigorous application of systematic evaluation of comorbidities may permit earlier detection, which may ultimately result in an improved outcome of patients with SpA.

Project Team

PI: Maxime Dougados

Steering committee: Anna Molto, Désirée van der Heijde, Robert Landewé, Filip van den Bosch.

Working group: Wilson Bautista Molano (Colombia), Ruben Burgos-Vargas (Mexico), Peter P Cheung (Singapore), Eduardo Collantes-Estevez (Spain), Atul Deodhar (UK), Bassel El-Zorkany (Egypt), Shandor Erdes (Rusia), Jieruo Gu(China), Najia Hajjaj-Hassouni (Morocco), Uta Kiltz(Germany), Tae-Hwan Kim( Korea), Mitsumasa Kishimoto(Japan), Shue-Fen Luo(Taiwan), Pedro M Machado (Portugal), Walter P Maksymowych (Canada), José Maldonado-Cocco (Argentina), Helena Marzo-Ortega (UK), Carlo-Maurizio Montecucco (Italy), Salih Ozgoçmen (Turkey), Floris van Gaalen (The Netherlands)

Publications

1: Carvalho PD, Vieira-Sousa E, Hmamouchi I, Marreiros A, Machado PM.

Determinants of health-related quality of life in spondyloarthritis and

rheumatoid arthritis – data from the COMOSPA and COMORA studies. Semin Arthritis

Rheum. 2022 Aug 27;57:152086. doi: 10.1016/j.semarthrit.2022.152086. Epub ahead

of print. PMID: 36115216.

2: Puche-Larrubia MÁ, Ladehesa-Pineda L, Font-Ugalde P, Escudero-Contreras A,

Moltó A, López-Medina C, Collantes-Estévez E. Distribution of comorbidities in

spondyloarthritis with regard to the phenotype and psoriasis: data from the

ASAS-COMOSPA study. Ther Adv Musculoskelet Dis. 2021 Sep

20;13:1759720X211045263. doi: 10.1177/1759720X211045263. PMID: 34567275; PMCID:

PMC8458671.

3: Kishimoto M, Ono K, Fukui S, Kawaai S, Deshpande GA, Yoshida K, Ichikawa N,

Kaneko Y, Kawasaki T, Matsui K, Morita M, Tada K, Takizawa N, Tamura N,

Taniguchi A, Taniguchi Y, Tsuji S, Okada M, Kobayashi S, Komagata Y, López-

Medina C, Molto A, van der Heijde D, Dougados M, Tomita T, Kaname S. Clinical

characteristics of non-radiographic versus radiographic axial spondyloarthritis

in Asia and non-radiographic axial spondyloarthritis in other regions: results

of the cross-sectional ASAS-COMOSPA study. RMD Open. 2021 Sep;7(3):e001752. doi:

10.1136/rmdopen-2021-001752. PMID: 34531305; PMCID: PMC8449957.

4: Arévalo M, López-Medina C, Moreno Martinez-Losa M, Moltó A, Font P,

Collantes-Estevez E, Gratacós J. Role of HLA-B27 in the comorbidities observed

in Axial Spondyloarthritis: Data from COMOSPA. Joint Bone Spine. 2020

Oct;87(5):445-448. doi: 10.1016/j.jbspin.2020.03.012. Epub 2020 Apr 3. PMID:

32251735.

5: Stolwijk C, Essers I, van den Bosch F, Dougados M, Etcheto A, van der Heijde

D, Landewé R, Molto A, van Tubergen A, Boonen A; ASAS-COMOSPA study group.

Validation of the self-administered comorbidity questionnaire adjusted for

spondyloarthritis: results from the ASAS-COMOSPA study. Rheumatology (Oxford).

2020 Jul 1;59(7):1632-1639. doi: 10.1093/rheumatology/kez482. PMID: 31665462;

PMCID: PMC7310090.

6: López-Medina C, Moltó A, Dougados M. Peripheral Manifestations in

Spondyloarthritis and their Effect: An Ancillary Analysis of the ASAS-COMOSPA

Study. J Rheumatol. 2020 Feb;47(2):211-217. doi: 10.3899/jrheum.181331. Epub

2019 Apr 15. PMID: 30988127.

7: Derakhshan MH, Goodson NJ, Packham J, Sengupta R, Molto A, Marzo-Ortega H,

Siebert S; BRITSpA and the ASAS-COMOSPA Investigators. Association of

Diverticulitis with Prolonged Spondyloarthritis: An Analysis of the ASAS-COMOSPA

International Cohort. J Clin Med. 2019 Feb 26;8(3):281. doi: 10.3390/jcm8030281.

PMID: 30813544; PMCID: PMC6462988.

8: Kishimoto M, Yoshida K, Ichikawa N, Inoue H, Kaneko Y, Kawasaki T, Matsui K,

Morita M, Suda M, Tada K, Takizawa N, Tamura N, Taniguchi A, Taniguchi Y, Tsuji

S, Haji Y, Rokutanda R, Yanaoka H, Cheung PP, Gu J, Kim TH, Luo SF, Okada M,

López Medina C, Molto A, Dougados M, Kobayashi S, van der Heijde D, Tomita T.

Clinical Characteristics of Patients with Spondyloarthritis in Japan in

Comparison with Other Regions of the World. J Rheumatol. 2019 Aug;46(8):896-903.

doi: 10.3899/jrheum.180412. Epub 2019 Feb 15. PMID: 30770497.

9: Putrik P, Ramiro S, Moltó A, Keszei AP, Norton S, Dougados M, van der Heijde

D, Landewé RBM, Boonen A. Individual-level and country-level socioeconomic

determinants of disease outcomes in SpA: multinational, cross-sectional study

(ASAS-COMOSPA). Ann Rheum Dis. 2019 Apr;78(4):486-493. doi:

10.1136/annrheumdis-2018-214259. Epub 2019 Jan 23. PMID: 30674477.

10: Derakhshan MH, Goodson NJ, Packham JC, Sengupta R, Molto A, Marzo-Ortega H,

Siebert S; BRITSpA and COMOSPA Investigators. Increased Risk of Hypertension

Associated with Spondyloarthritis Disease Duration: Results from the ASAS-

COMOSPA Study. J Rheumatol. 2019 Jul;46(7):701-709. doi: 10.3899/jrheum.180538.

Epub 2019 Jan 15. PMID: 30647169.

11: Rodrigues Manica S, Sepriano A, Ramiro S, Pimentel Santos F, Putrik P,

Nikiphorou E, Norton S, Molto A, Dougados M, van der Heijde D, Landewé RBM, van

den Bosch FE, Boonen A. Work participation in spondyloarthritis across

countries: analysis from the ASAS-COMOSPA study. Ann Rheum Dis. 2018

Sep;77(9):1303-1310. doi: 10.1136/annrheumdis-2018-213464. Epub 2018 Jun 2.

PMID: 29860232.

12: Couderc M, Pereira B, Molto A, Tiple A, Soubrier M, Dougados M. The

Prevalence of Renal Impairment in Patients with Spondyloarthritis: Results from

the International ASAS-COMOSPA Study. J Rheumatol. 2018 Jun;45(6):795-801. doi:

10.3899/jrheum.170133. Epub 2018 Apr 15. PMID: 29657148.

13: Bautista-Molano W, Landewé R, Burgos-Vargas R, Maldonado-Cocco J, Moltó A,

van den Bosch F, Valle-Oñate R, Dougados M, van der Heijde D. Prevalence of

Comorbidities and Risk Factors for Comorbidities in Patients with

Spondyloarthritis in Latin America: A Comparative Study with the General

Population and Data from the ASAS-COMOSPA Study. J Rheumatol. 2018

Feb;45(2):206-212. doi: 10.3899/jrheum.170520. Epub 2017 Dec 15. PMID: 29247152.

14: Nikiphorou E, van der Heijde D, Norton S, Landewé RB, Molto A, Dougados M,

Van den Bosch FE, Ramiro S. Inequity in biological DMARD prescription for

spondyloarthritis across the globe: results from the ASAS-COMOSPA study. Ann

Rheum Dis. 2018 Mar;77(3):405-411. doi: 10.1136/annrheumdis-2017-212457. Epub

2017 Dec 8. PMID: 29222349.

15: Fernandes S, Etcheto A, van der Heijde D, Landewé R, van den Bosch F,

Dougados M, Moltó A. Vitamin D status in spondyloarthritis: results of the ASAS-

COMOSPA international study. Clin Exp Rheumatol. 2018 Mar-Apr;36(2):210-214.

Epub 2017 Nov 16. PMID: 29148411.

16: López-Medina C, Jiménez-Gómez Y, Moltó A, Schiotis RE, Marzo-Ortega H, van

Gaalen FA, Ozgocmen S, Dougados M, Calvo-Gutiérrez J, Castro-Villegas MC,

Collantes-Estévez E, Font-Ugalde P; ASAS-COMOSPA task force. Cardiovascular risk

factors in patients with spondyloarthritis from Northern European and

Mediterranean countries: An ancillary study of the ASAS-COMOSPA project. Joint

Bone Spine. 2018 Jul;85(4):447-453. doi: 10.1016/j.jbspin.2017.07.006. Epub 2017

Jul 25. PMID: 28754402.

17: Bakker P, Moltó A, Etcheto A, Van den Bosch F, Landewé R, van Gaalen F,

Dougados M, van der Heijde D. The performance of different classification

criteria sets for spondyloarthritis in the worldwide ASAS-COMOSPA study.

Arthritis Res Ther. 2017 May 16;19(1):96. doi: 10.1186/s13075-017-1281-5. PMID:

28511725; PMCID: PMC5434574.

18: Moltó A, Etcheto A, van der Heijde D, Landewé R, van den Bosch F, Bautista

Molano W, Burgos-Vargas R, Cheung PP, Collantes-Estevez E, Deodhar A, El-Zorkany

B, Erdes S, Gu J, Hajjaj-Hassouni N, Kiltz U, Kim TH, Kishimoto M, Luo SF,

Machado PM, Maksymowych WP, Maldonado-Cocco J, Marzo-Ortega H, Montecucco CM,

Ozgoçmen S, van Gaalen F, Dougados M. Prevalence of comorbidities and evaluation

of their screening in spondyloarthritis: results of the international cross-

sectional ASAS-COMOSPA study. Ann Rheum Dis. 2016 Jun;75(6):1016-23. doi:

10.1136/annrheumdis-2015-208174. Epub 2015 Oct 21. PMID: 26489703.