Background Multimorbidity (MM) is highly prevalent in early RA (ERA), and higher counts of conditions are associated with poorer disease control1. It is important to understand the number of, and which specific conditions most affect disease presentation, early therapies and disease activity over time.
Objectives To estimate the prevalence of MM conditions at the time of ERA diagnosis and associations with ERA clinical characteristics, early treatment, and trajectory of disease activity in the 1st year of follow up.
Methods Data were from ERA patients (<1-year of symptoms) enrolled in CATCH (Canadian Early Arthritis Cohort) who met 1987 or 2010 RA criteria, and had at least two DAS28 measures in the first year. We examined baseline prevalence of: 1) cardiovascular disease (CVD), 2) diabetes, 3) cancer, 4) pulmonary disease, 5) bowel disease, 6) other rheumatic diseases, and 7) psoriasis, obtained from patient-reports of physician-diagnosed medical conditions, 8) obesity (BMI≥30), and 9) depressive symptoms (RAND-12 <42). We compared baseline demographic and clinical characteristics in ERA + each condition vs. ERA alone. We estimated adjusted effects of each condition on early use of RA therapies with logistic regression and adjusted effects of each condition on DAS28 trajectory over the first year of follow up with linear growth models.
Results The sample included 1,595 patients, 1153 (72%) were female, with a mean (sd) age of 54 (15) years and 6 (3) months of symptoms. At baseline 1,434 (92%) were treated with conventional DMARDs (mostly methotrexate (76%)) and 33 (2%) with a biologic. More than 70% of ERA patients reported at least one MM, and over 30% reported 2+ MMs. Patients with MM were often older and had higher disease activity at baseline, with variations by condition. Patients with RA+CVD or depressive symptoms had a 60% and 90% higher adjusted odds of baseline steroid use, respectively (p<.001). In fully adjusted growth models, relative to patients with ERA only, patients with: a) diabetes, other rheumatic diseases or depressive symptoms had higher baseline DAS28 scores and less improvement over time, b) pulmonary disease, bowel disease, psoriasis or obesity had similar baseline DAS28 scores but less improvement over time; and c) CVD or cancer had higher baseline DAS28 scores but similar improvement over time (all p<0.05).
Conclusions Multimorbidity is common in ERA patients seen in routine practice and associated with higher disease activity at baseline, less improvement over time, or both, and a greater likelihood of prescribing steroids for certain conditions. Integrating MM in to current RA care strategies may help achieve better patient outcomes.
Hitchon CA, et al. Self-reported comorbidity is common in early inflammatory arthritis and associated with poorer function and worse arthritis disease outcomes: results from the Canadian Early Arthritis Cohort. Rheumatology. 2016. doi: 10.1093/rheumatology/kew061.
Disclosure of Interest O. Schieir: None declared, S. Bartlett Consultant for: UCB, Pfizer, C. Hitchon: None declared, J. Pope Grant/research support from: Amgen, BMS, Pfizer, Roche, UCB, Consultant for: AbbVie, Actelion, Amgen, Bayer, BMS, Genzyme, Hospira, Lilly, Merck, Norvartis, Pfizer, Regeneron, Roche, Sanofi, UCB, G. Boire: None declared, B. Haraoui Grant/research support from: AbbVie, Amgen, BMS, Janssen, Pfizer, Roche and UCB, Consultant for: AbbVie, Amgen, BMS, Celgene, Eli Lilly Janssen, Merck, Pfizer, Roche and UCB, Speakers bureau: Amgen,BMS Janssen, Pfizer and UCB, E. Keystone Grant/research support from: Abbott Laboratories, Amgen Inc, AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb, F.Hoffmann-La Roche Inc, Janssen Inc, Lilly Pharmaceuticals, Novartis Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, UCB, Consultant for: Abbott Laboratories, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Crescendo Bioscience, F Hoffmann-La Roche Inc, Genentech Inc, Janssen Inc, Lilly Pharmaceuticals,Merck, Pfizer Pharmaceuticals, UCB, Speakers bureau: Abbott Laboratories, AstraZeneca LP, Bristol-Myers Squibb Canada, F Hoffmann-La Roche Inc, Janssen Inc, Pfizer Pharmaceuticals, UCB,Amgen, D. Tin: None declared, C. Thorne: None declared, V. Bykerk: None declared