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Rheumatoid arthritis
Comorbidity clusters in patients with rheumatoid arthritis identify a patient phenotype with a favourable prognosis
  1. Cynthia S Crowson1,2,
  2. Elizabeth J Atkinson1,
  3. Vanessa L Kronzer2,
  4. Bradly A Kimbrough2,
  5. Courtney A Arment2,
  6. Lynne S Peterson2,
  7. Kerry Wright2,
  8. Thomas G Mason II2,
  9. Delamo I Bekele2,
  10. John M Davis III2,
  11. Elena Myasoedova1,2
  1. 1 Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Cynthia S Crowson, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, USA; crowson{at}mayo.edu

Abstract

Objectives We aimed to cluster patients with rheumatoid arthritis (RA) based on comorbidities and then examine the association between these clusters and RA disease activity and mortality.

Methods In this population-based study, residents of an eight-county region with prevalent RA on 1 January 2015 were identified. Patients were followed for vital status until death, last contact or 31 December 2021. Diagnostic codes for 5 years before the prevalence date were used to define 55 comorbidities. Latent class analysis was used to cluster patients based on comorbidity patterns. Standardised mortality ratios were used to assess mortality.

Results A total of 1643 patients with prevalent RA (72% female; 94% white; median age 64 years, median RA duration 7 years) were studied. Four clusters were identified. Cluster 1 (n=686) included patients with few comorbidities, and cluster 4 (n=134) included older patients with 10 or more comorbidities. Cluster 2 (n=200) included patients with five or more comorbidities and high prevalences of depression and obesity, while cluster 3 (n=623) included the remainder. RA disease activity and survival differed across the clusters, with cluster 1 demonstrating more remission and mortality comparable to the general population.

Conclusions More than 40% of patients with prevalent RA did not experience worse mortality than their peers without RA. The cluster with the worst prognosis (<10% of patients with prevalent RA) was older, had more comorbidities and had less disease-modifying antirheumatic drug and biological use compared with the other clusters. Comorbidity patterns may hold the key to moving beyond a one-size-fits-all perspective of RA prognosis.

  • Rheumatoid Arthritis
  • Disease Activity
  • Arthritis, Rheumatoid
  • Epidemiology

Data availability statement

Data are available on reasonable request. Data are not available without approval from the Mayo Clinic Institutional Review Board. Requests should be sent via email to the corresponding author.

https://doi.org/10.1136/ard-2023-225093

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    Data availability statement

    Data are available on reasonable request. Data are not available without approval from the Mayo Clinic Institutional Review Board. Requests should be sent via email to the corresponding author.

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    Footnotes

    • Handling editor Josef S Smolen

    • X @KronzerMD, @JohnDavisIII, @MyasoedovaElena

    • Contributors CSC, EJA, VLK, JD and EM contributed to the conception and design of the study. CSC, EJA, JD and EM prepared material and collected data. Data were analysed by CSC and EJA. Data were interpreted by CSC, EJA, VLK, BAK, CA, LSP, KW, TGM, DB, JD and EM. CSC and EJA directly accessed and verified the underlying data. The first draft of the manuscript was written by CSC, EJA and EM. All authors had full access to all the data in the study, read and approved the final version of the manuscript and had final responsibility for the decision to submit for publication. CSC is the guarantor.

    • Funding This work was funded by grants from the National Institutes of Health (NIH), National Institute of Arthritis, Musculoskeletal and Skin Diseases (R01 AR46849) and National Institute on Aging (R01 AG068192, K24 AG078179).

    • Disclaimer The content of this article is solely the responsibility of the authors and does not represent the official views of the NIH or the Mayo Clinic.

    • Competing interests JMD has received research support from Pfizer, has a patent pending for assessing and treating arthritis, has licensed intellectual property with Girihlet and Remission Medical and serves on a data safety monitoring board for a rheumatoid arthritis clinical trial sponsored by the US National Institutes of Health, all unrelated to this work. All other authors declare no conflict of interest.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.