Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Population-Based Estimates of Common Comorbidities and Cardiovascular Disease in Ankylosing Spondylitis.

Bremander2,  Ann B. I., Petersson1,  Ingemar F., Bergman4,  Stefan, Englund3,  Martin

Lund University Hosp, Lund, Sweden
Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences Lund, Lund University, Oskarstrom, Sweden
Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarstrom, Sweden

Background:

Comorbidities associated with AS contribute to the burden of the rheumatic disease. However, epidemiologic studies presenting estimates of the increased rate of comorbidities in AS are scarce.

Objective:

To study the rate of common comorbidities and cardiovascular disease in ankylosing spondylitis (AS) patients compared with the general population seeking health care.

Methods:

Sweden has a publicly funded health care system. All health care utilization is registered by the patients' personal identifier in databases. We studied 1374 subjects (60% men) age >=20 years, living in the county of Skåne, Sweden, who were registered with an AS diagnosis (ICD-10 code M45) in the Skåne Health Care Register at least once during 4 calendar years (2004 to 2007). We then recorded the occurrence of physicians' diagnostic codes for a select number of comorbidities commonly associated with AS or cardiovascular disease or its risk factors. To obtain morbidity rates we calculated the person-time from the day after the first occurrence of the AS diagnosis within the study period until the first diagnosis of the disease or another censoring event (death/relocation). We then obtained standardized morbidity ratios (SMRs) by dividing the observed morbidity rate in AS patients by the expected based on the corresponding rate of the disease in the general health care seeking population of the county (761 210 inhabitants aged >=20); an SMR >1 equals a higher rate of the disease among AS patients than in the general population of corresponding age and sex distribution.

Results:

The highest SMRs were found for uveitis 26.06 (95% CI 21.97, 30.70) and inflammatory bowel disease 8.19 (95% CI 6.47, 10.22), Figure 1. Also, we found increased SMRs for ischemic heart diseases 1.83 (95% CI 1.53, 2.18), hypertension 1.70 (95% CI 1.51, 1.91), disorders of lipoprotein metabolism 1.34 (95% CI 1.04, 1.71), and diabetes mellitus 1.34 (95% CI 1.10, 1.62). Within the group of ischemic heart diseases we also evaluated acute myocardial infarction separately and although it is a relatively rare event the SMR was close to be significantly elevated; 1.43 (95% CI 0.97, 2.03), Figure 2. Further, the SMRs for psoriasis, osteoporosis, and atrioventricular blocks were also statistically significantly elevated.

Figure 1

Figure 1.

Conclusion:

Inflammatory diseases affecting the eye and the digestive system were the most notable comorbidities in AS patients, but the rate for cardiovascular disease was also higher indicating that AS is a chronic rheumatic disease with strong influence of comorbidities affecting the total burden of the disease.

To cite this abstract, please use the following information:
Bremander, Ann B. I., Petersson, Ingemar F., Bergman, Stefan, Englund, Martin; Population-Based Estimates of Common Comorbidities and Cardiovascular Disease in Ankylosing Spondylitis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2209
DOI: 10.1002/art.29973

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