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Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA)
  1. Maxime Dougados1,2,
  2. Martin Soubrier3,
  3. Anna Antunez4,
  4. Peter Balint5,
  5. Alejandro Balsa6,
  6. Maya H Buch7,8,
  7. Gustavo Casado9,
  8. Jacqueline Detert10,
  9. Bassel El-zorkany11,
  10. Paul Emery7,8,
  11. Najia Hajjaj-Hassouni12,
  12. Masayoshi Harigai13,
  13. Shue-Fen Luo14,
  14. Reka Kurucz5,
  15. Gabriel Maciel15,
  16. Emilio Martin Mola16,
  17. Carlo Maurizio Montecucco17,
  18. Iain McInnes18,
  19. Helga Radner19,
  20. Josef S Smolen19,
  21. Yeong-Wook Song20,
  22. Harald Erwin Vonkeman21,
  23. Kevin Winthrop22,
  24. Jonathan Kay23
  1. 1Medicine Faculty, Paris-Descartes University, Paris, France
  2. 2Rheumatology B Department, APHP, Cochin Hospital, Paris, France
  3. 3Department of Rheumatology, CHU Clermont-Ferrand, France
  4. 4Rheumatology Unit, Central Hospital “Dr Urquinaona”, Maracaibo, Venezuela
  5. 53rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
  6. 6Rheumatology Unit, La Paz University Hospital, Madrid, Spain
  7. 7Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, UK
  8. 8NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS, UK
  9. 9Department of Rheumatology, Hospital Militar Central, Buenos Aires, Argentina
  10. 10Rheumatology Department, Charité University Medicine, Berlin, Germany
  11. 11Department of Rheumatology, Cairo University, Cairo, Egypt
  12. 12Rheumatology Department, El Ayachi Hospital, Salé, Morocco
  13. 13Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan
  14. 14Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan
  15. 15Clínica Médica 1, Hospital Maciel, Universidad de la República, Montevideo, Uruguay
  16. 16Department of Rheumatology, La Paz University Hospital, Madrid, Spain
  17. 17Division of Rheumatology, IRCCS policlinico S. Matteo foundation, University of Pavia, Pavia, Italy
  18. 18Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
  19. 19Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, and 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria
  20. 20Department of Rheumatology, Seoul National University Hospital, Seoul, Korea
  21. 21Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente and University of Twente, Enschede, The Netherlands
  22. 22Division of Infectious Diseases, Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon, USA
  23. 23Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, Massachusetts, USA
  1. Correspondence to Professor Maxime Dougados, Rhumatologie B, Hôpital Cochin, 27 rue du Fg Saint-Jacques, Paris 75014, France; maxime.dougados{at}


Background Patients with rheumatoid arthritis (RA) are at increased risk of developing comorbid conditions.

Objectives To evaluate the prevalence of comorbidities and compare their management in RA patients from different countries worldwide.

Methods Study design: international, cross-sectional. Patients: consecutive RA patients. Data collected: demographics, disease characteristics (activity, severity, treatment), comorbidities (cardiovascular, infections, cancer, gastrointestinal, pulmonary, osteoporosis and psychiatric disorders).

Results Of 4586 patients recruited in 17 participating countries, 3920 were analysed (age, 56±13 years; disease duration, 10±9 years (mean±SD); female gender, 82%; DAS28 (Disease Activity Score using 28 joints)–erythrocyte sedimentation rate, 3.7±1.6 (mean±SD); Health Assessment Questionnaire, 1.0±0.7 (mean±SD); past or current methotrexate use, 89%; past or current use of biological agents, 39%. The most frequently associated diseases (past or current) were: depression, 15%; asthma, 6.6%; cardiovascular events (myocardial infarction, stroke), 6%; solid malignancies (excluding basal cell carcinoma), 4.5%; chronic obstructive pulmonary disease, 3.5%. High intercountry variability was observed for both the prevalence of comorbidities and the proportion of subjects complying with recommendations for preventing and managing comorbidities. The systematic evaluation of comorbidities in this study detected abnormalities in vital signs, such as elevated blood pressure in 11.2%, and identified conditions that manifest as laboratory test abnormalities, such as hyperglycaemia in 3.3% and hyperlipidaemia in 8.3%.

Conclusions Among RA patients, there is a high prevalence of comorbidities and their risk factors. In this multinational sample, variability among countries was wide, not only in prevalence but also in compliance with recommendations for preventing and managing these comorbidities. Systematic measurement of vital signs and laboratory testing detects otherwise unrecognised comorbid conditions.

  • Rheumatoid Arthritis
  • Cardiovascular Disease
  • Epidemiology
  • Lipids
  • Vaccination

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