{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T03:34:52Z","timestamp":1783568092319,"version":"3.55.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T00:00:00Z","timestamp":1599696000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T00:00:00Z","timestamp":1599696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Bildung und Forschung","doi-asserted-by":"publisher","award":["01EC1405"],"award-info":[{"award-number":["01EC1405"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arthritis Res Ther"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>In contrast to other chronic rheumatic musculoskeletal diseases such as rheumatoid arthritis, comorbidities in axial spondyloarthritis (axSpA) and their impact on disease outcomes are less well studied. The aim of this study was to investigate the prevalence of comorbidities and their association with disease activity and functional impairment in a large population-based cohort of patients with axSpA.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A random sample of patients with axSpA, stratified by age and sex, was drawn from health insurance data. Patients in the sample received a survey on demographic, socioeconomic, and disease-related parameters. Comorbidities were defined using the Elixhauser coding algorithms excluding rheumatoid arthritis\/collagen vascular diseases and including osteoporosis and fibromyalgia, resulting in a set of 32 comorbidities. The prevalence of comorbidities in the axSpA patients and their pharmacological treatment were examined. Multivariable linear regression models were calculated to determine the association of comorbidities with disease activity and functional status.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 1776 axSpA patients were included in the analyses (response, 47%; mean age, 56\u2009years; 46% female). The most prevalent comorbidities were hypertension, depression, and chronic pulmonary disorders. The number of comorbidities was significantly associated with both the BASDAI and BASFI: <jats:italic>\u03b2<\/jats:italic> (95% CI)\u2009=\u20090.17 (0.09\u20130.24) and 0.24 (0.15\u20130.32), respectively. When analysed separately, hypertension, depression, and chronic pulmonary disease were comorbidities with a significant and independent association with BASFI, while for BASDAI, such an association was found for depression and chronic pulmonary disease only.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Comorbidities are common in axSpA patients and are associated with higher disease activity and higher levels of functional impairment. Higher disease activity and higher levels of functional impairment might be indicators of severe disease resulting in the development of comorbidities.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s13075-020-02301-0","type":"journal-article","created":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T19:29:46Z","timestamp":1599766186000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["The prevalence and impact of comorbidities on patients with axial spondyloarthritis: results from a nationwide population-based study"],"prefix":"10.1186","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3377-2683","authenticated-orcid":false,"given":"Imke","family":"Redeker","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Callhoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Falk","family":"Hoffmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula","family":"Marschall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hildrun","family":"Haibel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Sieper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Zink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Poddubnyy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,9,10]]},"reference":[{"issue":"6","key":"2301_CR1","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1136\/ard.2009.108233","volume":"68","author":"M Rudwaleit","year":"2009","unstructured":"Rudwaleit M, van der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J, et al. The development of assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777\u201383.","journal-title":"Ann Rheum Dis"},{"issue":"10089","key":"2301_CR2","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/S0140-6736(16)31591-4","volume":"390","author":"J Sieper","year":"2017","unstructured":"Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390(10089):73\u201384.","journal-title":"Lancet."},{"issue":"3","key":"2301_CR3","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1016\/j.berh.2018.09.002","volume":"32","author":"A Molto","year":"2018","unstructured":"Molto A, Dougados M. Comorbidities in spondyloarthritis including psoriatic arthritis. Best Pract Res Clin Rheumatol. 2018;32(3):390\u2013400.","journal-title":"Best Pract Res Clin Rheumatol"},{"issue":"6","key":"2301_CR4","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1136\/annrheumdis-2015-208174","volume":"75","author":"A Molto","year":"2016","unstructured":"Molto A, Etcheto A, van der Heijde D, Landewe R, van den Bosch F, Bautista Molano W, et al. Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis. 2016;75(6):1016\u201323.","journal-title":"Ann Rheum Dis"},{"issue":"8","key":"2301_CR5","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.1002\/acr.23468","volume":"70","author":"E Nikiphorou","year":"2018","unstructured":"Nikiphorou E, Ramiro S, van der Heijde D, Norton S, Molto A, Dougados M, et al. Association of comorbidities in spondyloarthritis with poor function, work disability, and quality of life: results from the assessment of SpondyloArthritis International Society Comorbidities in Spondyloarthritis Study. Arthritis Care Res (Hoboken). 2018;70(8):1257\u201362.","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2301_CR6","doi-asserted-by":"crossref","unstructured":"Zhao SS, Radner H, Siebert S, Duffield SJ, Thong D, Hughes DM, et al. Comorbidity burden in axial spondyloarthritis: a cluster analysis. Rheumatology (Oxford). 2019;58(10):1746\u201354.","DOI":"10.1093\/rheumatology\/kez119"},{"issue":"1","key":"2301_CR7","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","volume":"36","author":"A Elixhauser","year":"1998","unstructured":"Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8\u201327.","journal-title":"Med Care"},{"issue":"9","key":"2301_CR8","doi-asserted-by":"publisher","first-page":"e65","DOI":"10.1097\/MLR.0b013e318297429c","volume":"53","author":"SR Austin","year":"2015","unstructured":"Austin SR, Wong YN, Uzzo RG, Beck JR, Egleston BL. Why summary comorbidity measures such as the Charlson Comorbidity Index and Elixhauser Score Work. Med Care. 2015;53(9):e65\u201372.","journal-title":"Med Care"},{"issue":"4","key":"2301_CR9","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1097\/01.mlr.0000118861.56848.ee","volume":"42","author":"DA Southern","year":"2004","unstructured":"Southern DA, Quan H, Ghali WA. Comparison of the Elixhauser and Charlson\/Deyo methods of comorbidity measurement in administrative data. Med Care. 2004;42(4):355\u201360.","journal-title":"Med Care"},{"issue":"5","key":"2301_CR10","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1002\/art.21440","volume":"53","author":"KL Dominick","year":"2005","unstructured":"Dominick KL, Dudley TK, Coffman CJ, Bosworth HB. Comparison of three comorbidity measures for predicting health service use in patients with osteoarthritis. Arthritis Rheum. 2005;53(5):666\u201372.","journal-title":"Arthritis Rheum"},{"key":"2301_CR11","doi-asserted-by":"crossref","unstructured":"Haibel H, Redeker I, Zink A, Callhoff J, Marschall U, Hoffmann F, et al. [Health care and disease burden in persons with axial spondyloarthritis in Germany]. Z Rheumatol. 2019;78(9):865\u201374.","DOI":"10.1007\/s00393-019-0650-7"},{"issue":"7","key":"2301_CR12","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1136\/annrheumdis-2017-212629","volume":"77","author":"I Redeker","year":"2018","unstructured":"Redeker I, Hoffmann F, Callhoff J, Haibel H, Sieper J, Zink A, et al. Determinants of psychological well-being in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data. Ann Rheum Dis. 2018;77(7):1017\u201324.","journal-title":"Ann Rheum Dis"},{"issue":"12","key":"2301_CR13","first-page":"2286","volume":"21","author":"S Garrett","year":"1994","unstructured":"Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994;21(12):2286\u201391.","journal-title":"J Rheumatol"},{"issue":"12","key":"2301_CR14","first-page":"2281","volume":"21","author":"A Calin","year":"1994","unstructured":"Calin A, Garrett S, Whitelock H, Kennedy LG, O\u2019Hea J, Mallorie P, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol. 1994;21(12):2281\u20135.","journal-title":"J Rheumatol"},{"issue":"3","key":"2301_CR15","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1159\/000376585","volume":"84","author":"CW Topp","year":"2015","unstructured":"Topp CW, Ostergaard SD, Sondergaard S, Bech P. The WHO-5 Well-Being Index: a systematic review of the literature. Psychother Psychosom. 2015;84(3):167\u201376.","journal-title":"Psychother Psychosom"},{"issue":"11","key":"2301_CR16","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","volume":"43","author":"H Quan","year":"2005","unstructured":"Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130\u20139.","journal-title":"Med Care"},{"issue":"6","key":"2301_CR17","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1136\/ard.2009.116178","volume":"69","author":"J-H Kang","year":"2010","unstructured":"Kang J-H, Chen Y-H, Lin H-C. Comorbidity profiles among patients with ankylosing spondylitis: a nationwide population-based study. Ann Rheum Dis. 2010;69(6):1165\u20138.","journal-title":"Ann Rheum Dis"},{"issue":"9836","key":"2301_CR18","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/S0140-6736(12)60240-2","volume":"380","author":"K Barnett","year":"2012","unstructured":"Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37\u201343.","journal-title":"Lancet."},{"key":"2301_CR19","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1186\/1471-2458-13-1161","volume":"13","author":"CB Agborsangaya","year":"2013","unstructured":"Agborsangaya CB, Ngwakongnwi E, Lahtinen M, Cooke T, Johnson JA. Multimorbidity prevalence in the general population: the role of obesity in chronic disease clustering. BMC Public Health. 2013;13:1161.","journal-title":"BMC Public Health"},{"key":"2301_CR20","doi-asserted-by":"crossref","unstructured":"Luque Ramos A, Redeker I, Hoffmann F, Callhoff J, Zink A, Albrecht K. Comorbidities in Patients with Rheumatoid Arthritis and Their Association with Patient-reported Outcomes: Results of Claims Data Linked to Questionnaire Survey. J Rheumatol. 2019;46(6):564\u201371.","DOI":"10.3899\/jrheum.180668"},{"issue":"7","key":"2301_CR21","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.3899\/jrheum.141534","volume":"42","author":"H Radner","year":"2015","unstructured":"Radner H, Yoshida K, Hmamouchi I, Dougados M, Smolen JS, Solomon DH. Treatment patterns of multimorbid patients with rheumatoid arthritis: results from an international cross-sectional study. J Rheumatol. 2015;42(7):1099\u2013104.","journal-title":"J Rheumatol"},{"issue":"7","key":"2301_CR22","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1002\/acr.22244","volume":"66","author":"E Yelin","year":"2014","unstructured":"Yelin E, Tonner C, Kim SC, Katz JN, Ayanian JZ, Brookhart MA, et al. Sociodemographic, disease, health system, and contextual factors affecting the initiation of biologic agents in rheumatoid arthritis: a longitudinal study. Arthritis Care Res (Hoboken). 2014;66(7):980\u20139.","journal-title":"Arthritis Care Res (Hoboken)."},{"issue":"8","key":"2301_CR23","doi-asserted-by":"publisher","first-page":"906","DOI":"10.1093\/rheumatology\/kep129","volume":"48","author":"BJ Radovits","year":"2009","unstructured":"Radovits BJ, Fransen J, Eijsbouts A, van Riel PL, Laan RF. Missed opportunities in the treatment of elderly patients with rheumatoid arthritis. Rheumatology (Oxford). 2009;48(8):906\u201310.","journal-title":"Rheumatology (Oxford)"},{"issue":"9","key":"2301_CR24","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.1136\/ard.2005.051144","volume":"65","author":"Z Tutuncu","year":"2006","unstructured":"Tutuncu Z, Reed G, Kremer J, Kavanaugh A. Do patients with older-onset rheumatoid arthritis receive less aggressive treatment? Ann Rheum Dis. 2006;65(9):1226\u20139.","journal-title":"Ann Rheum Dis"},{"issue":"21","key":"2301_CR25","doi-asserted-by":"publisher","first-page":"1516","DOI":"10.1056\/NEJM199805213382106","volume":"338","author":"DA Redelmeier","year":"1998","unstructured":"Redelmeier DA, Tan SH, Booth GL. The treatment of unrelated disorders in patients with chronic medical diseases. N Engl J Med. 1998;338(21):1516\u201320.","journal-title":"N Engl J Med"},{"issue":"4","key":"2301_CR26","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1016\/j.semarthrit.2008.01.004","volume":"38","author":"E Loza","year":"2009","unstructured":"Loza E, Jover JA, Rodriguez L, Carmona L, Group ES. Multimorbidity: prevalence, effect on quality of life and daily functioning, and variation of this effect when one condition is a rheumatic disease. Semin Arthritis Rheum. 2009;38(4):312\u20139.","journal-title":"Semin Arthritis Rheum"},{"key":"2301_CR27","doi-asserted-by":"crossref","unstructured":"Fitzgerald G, Gallagher P, O'Shea FD. Multimorbidity in Axial Spondyloarthropathy and Its Association with Disease Outcomes: Results from the Ankylosing Spondylitis Registry of Ireland Cohort. J Rheumatol. 2020;47(2):218\u201326.","DOI":"10.3899\/jrheum.181415"},{"issue":"3","key":"2301_CR28","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1002\/art.24483","volume":"60","author":"M Rudwaleit","year":"2009","unstructured":"Rudwaleit M, Haibel H, Baraliakos X, Listing J, Marker-Hermann E, Zeidler H, et al. The early disease stage in axial spondylarthritis: results from the german spondyloarthritis inception cohort. Arthritis Rheum. 2009;60(3):717\u201327.","journal-title":"Arthritis Rheum"},{"issue":"12","key":"2301_CR29","doi-asserted-by":"publisher","first-page":"3096","DOI":"10.1002\/art.38140","volume":"65","author":"A Ciurea","year":"2013","unstructured":"Ciurea A, Scherer A, Exer P, Bernhard J, Dudler J, Beyeler B, et al. Tumor necrosis factor alpha inhibition in radiographic and nonradiographic axial spondyloarthritis: results from a large observational cohort. Arthritis Rheum. 2013;65(12):3096\u2013106.","journal-title":"Arthritis Rheum"},{"issue":"9","key":"2301_CR30","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1002\/acr.21688","volume":"64","author":"U Kiltz","year":"2012","unstructured":"Kiltz U, Baraliakos X, Karakostas P, Igelmann M, Kalthoff L, Klink C, et al. Do patients with non-radiographic axial spondylarthritis differ from patients with ankylosing spondylitis? Arthritis Care Res (Hoboken). 2012;64(9):1415\u201322.","journal-title":"Arthritis Care Res (Hoboken)."}],"container-title":["Arthritis Research &amp; Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13075-020-02301-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13075-020-02301-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13075-020-02301-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,10]],"date-time":"2021-09-10T00:05:17Z","timestamp":1631232317000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthritis-research.biomedcentral.com\/articles\/10.1186\/s13075-020-02301-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,10]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["2301"],"URL":"https:\/\/doi.org\/10.1186\/s13075-020-02301-0","relation":{},"ISSN":["1478-6362"],"issn-type":[{"value":"1478-6362","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,10]]},"assertion":[{"value":"14 April 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 August 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 September 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was approved by the ethics committee of the Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Berlin, Germany. Patients\u2019 written informed consent on the linkage of survey data to health insurance data was obtained in all cases.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"I. Redeker, J. Callhoff, F. Hoffmann, and A. Zink declare no conflicts of interest. U. Marschall is an employee of BARMER. H. Haibel reports consulting fees or members of the speakers\u2019 bureau from AbbVie, Janssen, MSD, Novartis, Pfizer, and Roche. J. Sieper reports consulting fees or members of the speakers\u2019 bureau from AbbVie, Janssen, Lilly, MSD, Novartis, and Pfizer and grants from AbbVie, MSD, and Pfizer. D. Poddubnyy reports consulting fees or members of the speakers\u2019 bureau from AbbVie, BMS, Celgene, Lilly, MSD, Novartis, Pfizer, Roche, and UCB and grants from AbbVie, MSD, Novartis, and Pfizer.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"210"}}