Background Comorbidities are highly prevalent in patients with Rheumatoid Arthritis (RA) and have been demonstrated to influence disease outcome. A better awareness of the number and type of comorbidities at disease onset and their influence on the disease course, could allow more timely intervention to prevent long term morbidity and mortality.
Objectives To investigate the presence of comorbidities in patients with recently diagnosed RA, its association with clinical features and impact on disease outcome.
Methods The presence of comorbidities was recorded on screening, before initiation of DMARDS or glucocorticoids in 379 patients with recently diagnosed RA (<1 year) participating in the Care in early RA (CareRA) trial, an RCT comparing different intensive remission induction strategies in a treat to target setting after stratification in a high- or low-risk arm based on classical prognostic markers (RF/ACPA, DAS28, erosion). Patients were grouped as having no comorbidities or having a comorbidity in at least one predefined category (cardiovascular, respiratory, endocrine, musculoskeletal, renal, neurobiological, psychiatric conditions, malignancies, metabolic disturbances, extra-articular RA manifestations and other). Disease activity (DAS28-ESR/CRP) was measured at baseline and after 1 year. Demographics including gender, age, smoking status, BMI and vital signs were registered on screening.
Results Out of 379 patients (289 high- and 90 low-risk), 262 (69.1%) had a comorbidity in at least one of the predefined categories. In the group with comorbidities, the mean age was significantly higher (54.7 vs 45.7, p<0.001), as was the systolic blood pressure (134.9 vs 129.3 mmHg, p=0.008), compared to the group without comorbidities. Moreover, DAS28-ESR (5.3 vs 4.8 p<0.001) and DAS28-CRP (4.9 vs 4.5 p=0.001) were significantly higher in patients with compared to without comorbidities. DAS28 scores also tended to increase depending on the number of comorbidities per individual. After 1 year of intensive treatment to target, no more statistically significant difference was seen between the group with or without baseline comorbidities in terms of DAS28-CRP scores, but DAS28-ESR remained higher in patients with comorbidities (p=0.031). Overall, the most frequently reported comorbidities were cardiovascular (35.1%), gastrointestinal (16.4%) and musculoskeletal (14.8%). No significant differences in prevalence were found between risk groups.
Conclusions At the onset of RA, nearly three-quarters of patients had a comorbidity in at least one category. Patients with comorbidities were significantly older and had a significantly higher disease activity at baseline, disappearing after one year of treatment. No significant difference in the number or type of comorbidities was found between so-called High- and Low-Risk patients.
Verschueren P, De Cock D, Corluy L, Joos R, Langenaken C, Taelman V et al. Methotrexate in combination with other DMARDs is not superior to methotrexate alone for remission induction with moderate-to-high-dose glucocorticoid bridging in early rheumatoid arthritis after 16 weeks of treatment: the CareRA trial. Annals of the Rheumatic Diseases. 2014;74(1):27–34.
Disclosure of Interest None declared