Evaluation of comorbid diseases of psoriatic arthritis patients followed up at Hacettepe University Hospital Rheumatology Outpatient Clinic and receiving biological treatment

The aim of this study is to determine the prevelence of comorbidities in Psoriatic Arthritis (PsA) patients receiving biological therapy (bDMARD), to examine the course of these diseases under bDMARD treatment, and to determine the effect of the number antype of chormobidity on disease activity. The study included 520 PsA patients who were followed up at Hacettepe University Internal Medicine Department, Rheumatology Department between 2005 and 2021 and received at least one bDMARD treatment. All patient records were analyzed retrospectively from the date of the first biological treatment. Accordingly, 159 (30.6%) of the patients were male. The mean age was calculated as 45.5 (12.5). 305/310 patients met the CASPAR criteria. The mean follow-up period was 44.8 (40.6) months. Charlson comorbidity index was calculated in 486 patients, with a mean of 1.17 (1.18) and a median of 1(1-7). 196/486 (40.3%) patients had at least 1 comorbidity. At the bDMARD baseline visit, 40.8% of patients were obese. Women had a higher BMI than men (29.6 vs 28.3 p:0.021). At the last visit, 41.7% of 367 patients with known BMI were obese. 9.7% of patients with known diabetes history at BDMARD baseline had a diagnosis of Diabetes. Diabetes was observed in 21 patients during follow-up, and the incidence of Diabetes was calculated as 1.33 (95% CI: 0.75-1.91) in 100 patient-years. At the BDMARD baseline visit, 21.9% of patients had hypertension. LDL-C, TG and total cholesterol was found to be high in respectively 49.1%, 28.3%,19.9% of patients with known lipid values. 17 (6.6%) Patients had coronary artery disease (CAD), 6 of them had premature CAD. CAD developed in 15 patients during follow-up. The incidence of CAD was 0.93 (95% CI 0.45-1.41) in 100 patient-years, while the incidence of Premature CAD was 0.68 (95% CI 0.21-0.95) in 100 patient-years. Patients with high DAS-28 scores in the period before BDMARD initiation were older, had more female gender, had higher number of comorbidities and higher BMI. Patients with a high HAQ-DI score were also similar. In the multivariate analysis performed, the presence of obesity and Diabetes at the onset of bDMARD negatively affected the DAS-28 treatment response (OR 1.06 (95% CI 1.02-1.11), OR 3.08 (95% CI 1.14-8.30) respectively). As a result, it is important to know the comorbidities of PsA patients receiving bDMARDs and to control the comorbidities in terms of clinical treatment response KEY WORDS: Psoriatic arthritis, disease-modifying anrheumatic drugs (biological), comorbidity, multimorbidity,