Pos0364 sex differential impact of co-morbidities on disease activity in spondyloarthritis: data from comospa study

Background Previous studies have examined the distinct phenotypes and the factors linked to disease activity and response to treatment in spondyloarthritis (SpA), some reporting several differences between men and women. However, there is still scarce literature on sex differences in SpA co-morbidities such as cardiovascular (CV) risk factors, osteoporosis, neoplasms or infections, or exploring sex differential impacts of these co-morbidities in the disease activity of SpA patients. Objectives To characterize differences in SpA associated co-morbidities between male and female patients and to evaluate the existence of a differential impact of these comorbidities on the disease activity between SpA gender. Methods This is a post-hoc analysis of the COMOSPA study which included 3982 patients with SpA, 2588 male patients and 1394 female patients. Differences in co-morbidities regarding sex were assessed using logistic regression models. Co-morbidities were evaluated for their impact on disease activity indexes with linear models, which included sex and the comorbidity as explanatory variables, as well as their interaction. Age and treatment with bDMARDS were included as confounders. We retrieved odds ratios (OR) and group differences from these models to measure the magnitude of the effects and determined statistical significance at a level of p<0.05 using Wald tests. Results After statistical control for age and bDMARDS, our analysis found that men had a higher prevalence of several cardiovascular comorbidities such as hypertension (OR, 95%CI) (1.47, 1.23 - 1.77), dyslipidemia (1.29, 1.07 - 1.56), ischemic heart disease (2.77, 1.72 - 4.65) and renal deficiency (2.36, 1.46 - 4.01). Additionally, a greater proportion of men had a history of tuberculosis (1.59, 1.45 - 3.95), and a lower prevalence of fibromyalgia (0.47, 0.39 - 0.57). However, we did not find differences between men and women in terms of prevalence of neoplasms, osteoporosis, gastrointestinal disease, or severe infection (Table 1). Several co-morbidities were associated with disease activity equally in both sex, including CV conditions, severe infection, osteoporosis, chronic obstructive pulmonary disease, gastrointestinal disease and fibromyalgia. When comparing men and women patients, gastrointestinal ulcer and fibromyalgia associates with ASDAS and BASDAI and have a differential impact depending on sex. Specifically, fibromyalgia has a higher impact in men (ASDAS: 1.367 vs 1.612; BASDAI: 4.28 vs 4.70) (Figure 1). Conclusion Our data show that co-morbidities occur similarly in men and female SpA patients, except for a higher frequency of CV co-morbidities in men and a higher prevalence of fibromyalgia in women. Moreover, fibromyalgia and gastro-intestinal ulcer evidenced a sex-specific association with disease activity among all the co-morbidities studied. Table 1. SpA patients Male, n=2588 Female, n=1394 p-value OR adjusted for age and ever bDMARDs p-value Age,years 42.9 (14.1) 45.1 (13.4) <0.001 Hypertension 590/2570 (23%) 292/1388 (21%) NS 1.47 (1.23 - 1.77) <0.001 Diabetes 147/2570 (5.7%) 72/1387 (5.2%) NS 1.27 (0.94 - 1.72) NS Dyslipidemia 438/2556 (17.1%) 218/1380 (15.8%) NS 1.29 (1.07 - 1.56) 0.009 Renal deficiency 74/2571 (2.9%) 20/1387 (1.4%) 0.005 2.36 (1.46 - 4.01) <0.001 Ischemic heart disease 85/2569 (3.3%) 21/1386 (1.5%) 0.001 2.77 (1.72 - 4.65) <0.001 Stroke 37/2570 (1.4%) 13/1381 (0.9%) NS 1.86 (1.00 - 3.66) NS History of tuberculosis 79/2548 (3.1%) 21/1382 (1.5%) 0.003 2.34 (1.45 - 3.95) <0.001 Hospitalized for severe infection 76/2556 (3%) 39/1385 (2.8%) NS 1.08 (0.73 - 1.61) NS Any neoplasm* 60/2486 (2.4%) 26/1342 (1.9%) NS 1.51 (0.94 - 2.48) NS Osteoporosis 341/2574 (13.2%) 188/1388 (13.5%) NS 1.06 (0.87 - 1.29) NS Any GI (diverticulitis or GI ulcer) 291/2558 (11.4%) 174/1376 (12.6%) NS 0.93 (0.76 - 1.14) NS FM (extreme PRO definition) 265/2569 (10.3%) 271/1384 (19.6%) <0.001 0.47 (0.39 - 0.57) <0.001 SpA= spondyloarthritis; GI= gastro-intestinal; bDMARDs: biological disease-modifying antirheumatic drugs; FM= fibromyalgia REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.