Abstract
Background/Aims
Psoriatic arthritis (PsA) is a heterogeneous disease with numerous articular phenotypes and extra-articular disease features. Patients with PsA have a higher risk of developing comorbidities. Studies in other chronic rheumatic diseases have shown comorbidity burden to be associated with poorer outcomes. The aims of this systematic review and meta-analysis were to: 1) describe the prevalence of comorbidities in PsA, 2) compare the incidence and/or prevalence of comorbidities between PsA and control populations; and 3) examine the impact of comorbidities on PsA outcomes.
Methods
Medline, PubMed, Scopus, and Web of Science were systematically searched using a predefined protocol in accordance with PRISMA guidelines. Exclusion criteria included: studies with risk of being non-representative of general PsA populations, studies reporting only one comorbidity, studies reporting psoriatic disease manifestations and pathomechanistically related conditions and other inflammatory arthritides. Where possible, meta-analysis was performed using random-effects models.
Results
A total of 3817 publications were returned by the literature search. After exclusions and de-duplication, 39 studies remained. Sample sizes ranged from 32 to 35,061 with a total of 158,797 PsA patients. The most frequently studied comorbidities were diabetes (n = 32 studies), hypertension (31) and hyperlipidaemia (18).
A meta-analysis for the prevalence of 21 commonly reported comorbidities was performed (table 1). The most prevalent comorbidities were hypertension (pooled prevalence 34%), metabolic syndrome (29%), obesity (27%), hyperlipidaemia (24%) and any cardiovascular disease (19%).
Eleven studies compared comorbidities between PsA and control groups. All except three studies matched or adjusted for potential confounders such as age and sex. Virtually all individual comorbidities had higher incidence and prevalence in the PsA group. The comorbidities and effect estimates were too heterogeneous to permit meta-analysis.
Five studies reported the impact of comorbidities on PsA outcomes. In most studies, PsA patients with comorbidity had greater pain, functional limitation, and poorer quality of life than those without. One study reported that metabolic syndrome-related comorbidities were significantly associated with TNFi discontinuation. P175 Table 1:Meta-analysis estimates for prevalence of individual comorbidities.No. of studiesNo. of individualsPooled prevalence95% confidence intervalI2, %RangeAny CVD124436919.47.8-34.11003.1-70.5Any IHD8296719.27.1-11.6970.6-18.2Angina358283.61.4-6.6941.9-5.1Myocardial infarction10176283.22.3-4.2871.3-8.1Heart failure8234551.31.0-1.7720.6-3.1Stroke15428722.81.5-4.5980.0-21.8PVD8446291.60.5-3.3990.0-6.2Hypertension318501434.228.6-40.21006.4-62.7Diabetes mellitus328997212.910.7-15.2992.0-34.1Hyperlipidaemia185981624.217.4-31.81002.9-79.8Obesity152789027.424.5-30.49512.7-39.8Metabolic syndrome5110928.814.0-46.2969.9-44.0Any GI disease5119769.97.9-12.0716.0-16.0Liver disease10732893.40.1-9.61000.0-26.5Any pulmonary disease66837012.36.3-19.81005.0-22.7COPD6125173.40-10.4991.1-17.3Depression149154111.97.4-17.21000.8-27.2Any cancer11636705.24.2-6.4961.5-9.2Renal disease8330512.50.8-4.9991.0-8.1Osteoporosis4182159.33.0-18.3993.8-14.0Thyroid disorders52531610.57.7-13.7940.6-15.0Stroke includes cerebrovascular accidents and transient ischaemic attacks. PVD, peripheral vascular disease; COPD, chronic obstructive pulmonary disease; GI gastrointestinal.
Conclusion
Comorbidities, particularly cardiometabolic disorders, were highly prevalent in PsA and more common than in controls. Comorbidities were associated with adverse disease features, but more research is needed on their impact on longitudinal clinical outcomes.
Disclosure
Z.J. Syrimi: None. S. Gupta: None. S.S. Zhao: None. D.M. Hughes: None.
Metabolic syndrome and its components among rheumatoid arthritis patients: A comprehensive updated systematic review and meta-analysis
