Background Patients with rheumatoid arthritis (RA) suffer from comorbidities that contribute to a shortened lifespan. Inflammation is of importance for the development of cardiovascular disease, but little is known on its relationship with other comorbidities in RA.
Objectives To examine the prevalence of comorbidities in early RA and the role of inflammation in this context.
Methods All patients with early RA (symptom duration <12 months) in Northern Sweden are since 1995 included in a prospective study on co-morbidities. By now 950 patients have been included. At the time of this compilation, 715 patients were followed-up of whom 498 had been ill for ≥5 years. Data on comorbidities, disease activity, x-ray (hands/feet), laboratory samples (autoantibodies, inflammatory variables) and pharmacological therapy were collected in record studies and further validated using a questionnaire at RA onset (T0) and after 5 years of disease (T5).
Results 53% had one or more comorbidities at RA onset. By then, the most common comorbidities were hypertension (26.3%), obstructive pulmonary disease (13.9%), diabetes (8.0%), hypothyroidism (6.3%) and malignancy (5.0%). After 5 years, 41% had developed at least one new comorbidity; most common were hypertension (15.1%), malignancy (7.8%), stroke/TIA (5.1%), myocardial infarction (4.3%) and osteoporosis (3.7%). Univariate regression analyses showed that age (p<0.001), ESR (p<0.01), extra-articular RA (p<0.01), corticosteroids (p<0.001) were associated with a new comorbidity during 5 years. Female gender and biologics reduced this risk (p<0.01 for both). In a multiple regression model adjusted for age, sex, smoking and corticosteroids, ESR were associated with a new comorbidity at follow-up. In a similar model, the relationship between ESR and endocrine comorbidity approached significance (p=0,10).
Conclusions There was substantial comorbidity among RA patients already at disease onset and considerable new comorbidity during the first five years of disease. Measures of disease activity were associated with occurrence of comorbidity.
Innala et al. Arthritis Res Ther 2011; 13: R131, Charlson et al. J Chron Dis, 1987; 40: 373-383, 25: 469-483, Norton et al. Rheumatol. 2013;52:99-110.
Disclosure of Interest None declared
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