Background Several patients with rheumatoid arthritis (RA) have different comorbidities and have to take other drugs at the same time. It is important to recognize such comorbidities in RA patients and consider them before initiating both pharmacotherapy and surgical therapy. Most of comorbidities in RA patients may affect therapeutic choice.
Objectives To evaluate the impact of comorbidities to physical functions and treatment selection of patients with RA, we studied comorbidity index in patients with rheumatoid arthritis in our Japanese cohort.
Methods A cohort of 413 Japanese patients with RA, who attended Toho University Ohmori hospital Rheumatology center during the period from 2005 to 2010, was retrospectively analyzed until the end 2010. Clinical data containing comorbidity profile and disease activity obtained from medical records. Comorbidity index used Charson comorbidity index; CCI established by Charlson M. et al. We analyzed relationship between the number of comorbidities, CCI and therapeutic processes of patients with rheumatoid arthritis.
Results In this cohort data profiles of RA patients were average age 65±14, female ratio 88%, average disease duration 8.3±8.8years, biologics usage 29%, DAS28-ESR 2.9±1.3 and Health Assessment Questionnaire disability index (HAQ-DI) was 0.6±0.7. Frequency of comorbidity was 53% in patients of this cohort. Comorbidities of RA patients were 27.9% hypertension, 12.3% diabetes mellitus, 12.3% interstitial peumonitis, 6.6% cardiovascular disease, 6.6% malignancy, 5.4% thyroid disease, and 2.7% renal diseases. The Japanese RA patient had low percentage of ischemic heart disease compared with a European and American report. Mean of CCI was 0.5±0.8. CCI was correlated with age and functional class classification. RA patients with low CCI included in RA functional class I group. CCI were also correlated with HAQ-DI and DAS28 ESR. RA patients with high CCI score (2$<)$ have treated by corticosteroid. And most of low CCI patients (<1) treated by methotrexate (MTX) (Fig). There is no significantly difference of MTX dose between each CCI groups. HAQ-DI were significantly correlated with sex (female), corticosteroid therapy, and CCI (0.38, 0.39, 0.15 p<0.01 respectively) by multiple regression analysis. HAQ-DI of RA patients improved by treatment of biologics (0.358 p<0.01). CCI of the patients with RA who had orthopedic surgical therapy were lower than the patients who received only pharmacotherapy. Comorbidities in the patients with orthopedic surgical therapy were related with elongation of hospitalization (p=0.39).
Conclusions CCI is one of the useful index in patients with RA. Therapeutic process of RA patients have been affected by several comorbidites. It is necessary to do treatment preferences in consideration of comorbidities. The therapy that we can choose without being concerned with a comorbidities is necessary in patients with rheumatoid arthritis.
Disclosure of Interest None Declared
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