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Research ArticleArticle

Increased Risk of Hypertension Associated with Spondyloarthritis Disease Duration: Results from the ASAS-COMOSPA Study

Mohammad H. Derakhshan, Nicola J. Goodson, Jonathan C. Packham, Raj Sengupta, Anna Molto, Helena Marzo-Ortega, Stefan Siebert and the BRITSpA and COMOSPA Investigators
The Journal of Rheumatology January 2019, jrheum.180538; DOI: https://doi.org/10.3899/jrheum.180538
Mohammad H. Derakhshan
From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK. The COMOSPA study was performed with financial support from AbbVie, Pfizer, and UCB, which provided an unrestricted grant to the Assessment of Spondyloarthritis international Society. Dr. Derakhshan’s work is supported by the British Society for Spondyloarthritis (BRITSpA). M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow. Address correspondence to S. Siebert, Institute of Infection, Immunity and Inflammation, University of Glasgow, Sir Graeme Davis Building, 120 University Place, Glasgow, G12 8TA, UK. E-mail: Stefan.Siebert@glasgow.ac.uk. Accepted for publication September 28, 2018.
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Nicola J. Goodson
From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK. The COMOSPA study was performed with financial support from AbbVie, Pfizer, and UCB, which provided an unrestricted grant to the Assessment of Spondyloarthritis international Society. Dr. Derakhshan’s work is supported by the British Society for Spondyloarthritis (BRITSpA). M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow. Address correspondence to S. Siebert, Institute of Infection, Immunity and Inflammation, University of Glasgow, Sir Graeme Davis Building, 120 University Place, Glasgow, G12 8TA, UK. E-mail: Stefan.Siebert@glasgow.ac.uk. Accepted for publication September 28, 2018.
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Jonathan C. Packham
From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK. The COMOSPA study was performed with financial support from AbbVie, Pfizer, and UCB, which provided an unrestricted grant to the Assessment of Spondyloarthritis international Society. Dr. Derakhshan’s work is supported by the British Society for Spondyloarthritis (BRITSpA). M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow. Address correspondence to S. Siebert, Institute of Infection, Immunity and Inflammation, University of Glasgow, Sir Graeme Davis Building, 120 University Place, Glasgow, G12 8TA, UK. E-mail: Stefan.Siebert@glasgow.ac.uk. Accepted for publication September 28, 2018.
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Raj Sengupta
From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK. The COMOSPA study was performed with financial support from AbbVie, Pfizer, and UCB, which provided an unrestricted grant to the Assessment of Spondyloarthritis international Society. Dr. Derakhshan’s work is supported by the British Society for Spondyloarthritis (BRITSpA). M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow. Address correspondence to S. Siebert, Institute of Infection, Immunity and Inflammation, University of Glasgow, Sir Graeme Davis Building, 120 University Place, Glasgow, G12 8TA, UK. E-mail: Stefan.Siebert@glasgow.ac.uk. Accepted for publication September 28, 2018.
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Anna Molto
From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK. The COMOSPA study was performed with financial support from AbbVie, Pfizer, and UCB, which provided an unrestricted grant to the Assessment of Spondyloarthritis international Society. Dr. Derakhshan’s work is supported by the British Society for Spondyloarthritis (BRITSpA). M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow. Address correspondence to S. Siebert, Institute of Infection, Immunity and Inflammation, University of Glasgow, Sir Graeme Davis Building, 120 University Place, Glasgow, G12 8TA, UK. E-mail: Stefan.Siebert@glasgow.ac.uk. Accepted for publication September 28, 2018.
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Helena Marzo-Ortega
From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK. The COMOSPA study was performed with financial support from AbbVie, Pfizer, and UCB, which provided an unrestricted grant to the Assessment of Spondyloarthritis international Society. Dr. Derakhshan’s work is supported by the British Society for Spondyloarthritis (BRITSpA). M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow. Address correspondence to S. Siebert, Institute of Infection, Immunity and Inflammation, University of Glasgow, Sir Graeme Davis Building, 120 University Place, Glasgow, G12 8TA, UK. E-mail: Stefan.Siebert@glasgow.ac.uk. Accepted for publication September 28, 2018.
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Stefan Siebert
From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK. The COMOSPA study was performed with financial support from AbbVie, Pfizer, and UCB, which provided an unrestricted grant to the Assessment of Spondyloarthritis international Society. Dr. Derakhshan’s work is supported by the British Society for Spondyloarthritis (BRITSpA). M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow. Address correspondence to S. Siebert, Institute of Infection, Immunity and Inflammation, University of Glasgow, Sir Graeme Davis Building, 120 University Place, Glasgow, G12 8TA, UK. E-mail: Stefan.Siebert@glasgow.ac.uk. Accepted for publication September 28, 2018.
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From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK. The COMOSPA study was performed with financial support from AbbVie, Pfizer, and UCB, which provided an unrestricted grant to the Assessment of Spondyloarthritis international Society. Dr. Derakhshan’s work is supported by the British Society for Spondyloarthritis (BRITSpA). M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow. Address correspondence to S. Siebert, Institute of Infection, Immunity and Inflammation, University of Glasgow, Sir Graeme Davis Building, 120 University Place, Glasgow, G12 8TA, UK. E-mail: Stefan.Siebert@glasgow.ac.uk. Accepted for publication September 28, 2018.
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Abstract

Objective Spondyloarthritis (SpA) is associated with a number of cardiovascular (CV) comorbidities. We examined the association of SpA disease duration and delay in diagnosis with CV-related conditions.

Methods Using data from the COMOSPA study, the associations between SpA disease duration and CV-related conditions were evaluated in univariable and multivariable logistic regression models. Each model examined 1 CV-related factor as dependent and “SpA disease duration” as a predictor, adjusted for relevant confounders.

Results Data from 3923 subjects (median SpA disease duration 5.1 yrs, interquartile range 1.3–11.8 yrs) were available for analysis. The main CV-related conditions were hypertension (HTN; 22.4%), ischemic heart disease (2.6%), stroke (1.3%), and diabetes mellitus (5.5%). HTN was associated with SpA disease duration in both univariable and multivariable analysis, with an OR of 1.129 (95% CI 1.072–1.189; p < 0.001) for each 5-year increase in SpA disease duration. Other factors associated with HTN were age, male sex, current body mass index, ever steroid therapy, and ever synthetic disease-modifying antirheumatic drug therapy, but not nonsteroidal antiinflammatory drugs (NSAID). In subgroup analysis, the strongest association of HTN and disease duration was seen in subjects with the axial-only SpA phenotype (OR 1.202, 95% CI 1.053–1.372) but not in those with peripheral-only SpA (OR 0.902, 95% CI 0.760–1.070). The other CV conditions were not associated with SpA disease duration.

Conclusion Duration of SpA disease in the ASAS-COMOSPA cohort is associated with higher odds of HTN, particularly in those with axial disease, but not with other CV-related conditions. The association with HTN does not appear to be related to NSAID exposure.

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Increased Risk of Hypertension Associated with Spondyloarthritis Disease Duration: Results from the ASAS-COMOSPA Study
Mohammad H. Derakhshan, Nicola J. Goodson, Jonathan C. Packham, Raj Sengupta, Anna Molto, Helena Marzo-Ortega, Stefan Siebert, the BRITSpA and COMOSPA Investigators
The Journal of Rheumatology Jan 2019, jrheum.180538; DOI: 10.3899/jrheum.180538

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Increased Risk of Hypertension Associated with Spondyloarthritis Disease Duration: Results from the ASAS-COMOSPA Study
Mohammad H. Derakhshan, Nicola J. Goodson, Jonathan C. Packham, Raj Sengupta, Anna Molto, Helena Marzo-Ortega, Stefan Siebert, the BRITSpA and COMOSPA Investigators
The Journal of Rheumatology Jan 2019, jrheum.180538; DOI: 10.3899/jrheum.180538
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