Background Patients with rheumatoid arthritis (RA) has been shown to be at increased risk for other diseases, in particular for osteoporosis, infections, cardiovascular diseases and malignancy. There are limited data on prevalence of comorbidities in unselected RA patient outpatient cohorts reflecting the magnitude of comorbidities in RA patients.
Objectives To explore the prevalence of comorbidities in RA patients followed at outpatient clinics in Norway.
Methods The RA patients were recruited from two outpatient clinics in Norway, one located in the southern and one in the western part of Norway. As part of clinical routine the RA patients at these two centers were monitored at ordinary visits by the use of the computer software tool GoTreatIT® Rheuma. Standardized data collection for disease activity measures, patient reported outcome measures (PROM) and treatment was registered as part of clinical routine. Patients also self-reported their comorbidities using the computer system. Patients with at least one visit in 2015 at the outpatient clinics were included.
Results A total of 2437 RA patients were assessed, 1065 from the southern and 1372 from the western located center. Only minor differences were found between the two centers, for demographic, disease and treatment variables. Patient demographic and disease characteristics: mean age 62.7 (SD 14.1) years, BMI 25.9 (4.5) kg/m2, education 11.8 (3.6) years, 70% females, current smoker 16.0% and 66.8% were RF+ and 73.5% were anti-CCP+. Measures reflecting disease activity: mean ESR 18.2 (14.4) mm/hr, CRP 7.0 (13.8) mg/dl, DAS28 2.4 (1.2) and CDAI 6.6 (7.0). Mean values for PROMs: Pain 32.7 (25.3) mm, fatigue 37.8 (29.8) mm. MHAQ 0.18 (0.42). Current user of mono synthetic disease modifying anti-rheumatic drugs (sDMARDs) 45.5%, mono biologic DMARDSs (bDMARDs) 10.4% and combination sDMARDs and bDMARDs 25.5%. Prednisolone was used by 40.8% of the patients.
Self-reported comorbidity data was available in 1616 of the 2437 (66.3%) patients. The percentage of patients reporting to have myocardial infarction was 3.9%, arterial hypertension16.5%, heart failure 1.2%, peripheral artery disease 1.7%, cerebrovascular disease 1.8%, osteoporosis 12.8%, chronic infections 3.7%, lymphoma 0.7%, melanoma 0.9%, other skin cancer 0.5%, other cancers 5.8%. Among the 123 patients who reported to have cancer 6.5% reported to have metastasis and 58.1% reported to have had ca treatment the last 5 years. Thyroid gland disease was reported by 8.0%, diabetes mellitus by 4.4% and peptic ulcer disease by 5.0%.
Conclusions Our data gives an estimate of the prevalence of the most frequent comorbidities in RA patients seen in Norwegian outpatient rheumatology clinics. Osteoporosis and cardiovascular disease was the most frequent comorbidities. Both of these comorbidities have been shown to be more frequent in RA patients compared with the background population. Data on prevalence of comorbidities may contribute to an increased awareness improving overall patient care in RA.
Disclosure of Interest G. Haugeberg Shareholder of: Founder of and shareholder in the company DiaGraphIT AS, B.-T. Fevang: None declared, D. Soldal: None declared, C. Gjesdal: None declared