Background Increased risk of cardio-vascular disease, infection and osteoporosis is well documented in RA. Some of these co-morbidities (e.g. cardiovascular disease risk) are subject to recommendations, with specific components relevant to RA. It is unclear whether such co-morbidity is recognized, or whether recommendations are applied in practice.
Objectives To evaluate: 1) the prevalence of RA co-morbidities in different countries worldwide and 2) the gap between available recommendations and daily practice concerning prevention/management of such co-morbidities.
Methods International, cross-sectional study of consecutive RA patients in routine care. Data comprise RA characteristics, plus relevant cardiovascular, infection, cancer, gastro-intestinal pulmonary, psychiatric disorders.
Results Seventeen participating countries (from 4 continents) included 4586 patients. Age: 56+13 years, disease duration: 10+9 years, female gender: 82%, DAS28-ESR: 3.7 + 1.6, HAQ1.0+0.7, any past or current intake of methotrexate (98%), of biotherapy (39%). The most frequent coincident diseases (past or current) were depression: 15%, asthma 6.6%, cardiovascular events (myocardial infarction, stroke) 6%, solid cancer (excluding basocellular carcinoma) 4.5%, and chronic obstructive pulmonary disease 3.5%. Substantial inter-country variability was observed both for prevalence of co-morbidities or coincident conditions [(e.g.% smokers from 3% (Morocco) to 48% (Austria), % with hepatitis (from 0% (France) to 7% (Egypt)] and also for the prevention/management of co-morbidities (e.g. pneumococcal vaccination from 0% (Netherlands) to 87% (Germany). Critically, systematic evaluation of co-morbidities permitted detection of previously undetected abnormalities [e.g. elevated blood pressure (11.2%), hyperglycemia (5.8%)] and serving to emphasise the sub-optimal management of such co-morbidities (e.g. of 236 patients with a history of cardiovascular events, 74 (32%) were not on anti-thrombotic therapy).
Conclusions This study suggests a) high prevalence of co-morbidities in RA, b) substantial inter-country variability c) variable detection of relevant risk factors and application of preventive strategies (e.g. vaccination). The study strongly suggests that rigorous application of systematic evaluation of co-morbidities could permit earlier detection and disciplined management with attendant improvement in outcomes in RA.
Acknowledgements This study was conducted thanks to an unrestricted grant from Roche Ltd
Disclosure of Interest None Declared