Baseline comorbidities in patients with rheumatoid arthritis who have been prescribed biological therapy: A case control study

Espiño-Lorenzo, Pilar; Manrique‐Arija, Sara; Ureña, I.; Jiménez-Núñez, F. G.; López-Lasanta, María; Romero-Barco, Carmen María; Belmonte-López, María Angeles; Irigoyen, M.V.; Fernández‐Nebro, Antonio

doi:10.1016/j.reuma.2012.05.012

Cited by 18 publications

(13 citation statements)

References 34 publications

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“…[ 5 ] On the other hand, 2 prior studies encounter that more male patients frequently have more comorbidities among RA patients. [ 2 , 21 ] This conclusion is incompatible with our study.…”

Section: Discussioncontrasting

confidence: 99%

“…In addition to RA, patients with at least 1 comorbidities were defined as “comorbidity positive,” others were “comorbidity negative.” In addition to RA, patients with at least 2 comorbidities were defined as multi-comorbidities. [ 2 , 19 ]…”

Section: Methodsmentioning

confidence: 99%

“…At least 60% RA patients have 1 comorbidity, furthermore 29% RA patients have multimorbidities. [ 2 ] Although, RA is a burdensome disease for most of the patients, comorbidities usually provide additional disadvantageous contribution to RA course. [ 3 ]…”

Section: Introductionmentioning

confidence: 99%

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Starting of biological disease modifying antirheumatic drugs may be postponed in rheumatoid arthritis patients with multimorbidity

et al. 2018

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The objective of this study was to assess the frequency of comorbidities and multimorbidities in rheumatoid arthritis (RA) patients under biologic therapy and their effects on biological disease modifying antirheumatic drugs (DMARDs) choice, timing, and response.Hacettepe University Biologic Registry (HUR-BIO) is single center biological DMARD registry. Cardiovascular, infectious, cancer, and other comorbidities were recorded with face to face interviews. Multimorbidity is defined as >1 comorbidity. Disease duration, initial date of biological DMARDs, initial and overall biological DMARD choice were recorded. Disease activity score-28 (DAS-28) responses were compared to comorbidity presence and multimorbidity.Total of 998 RA patients were enrolled into the study. The mean age was 53.1 (12.5) and mean disease duration (standard deviation [SD]) was 11.7 (7.5) years. At least 1 comorbidity was detected in 689 (69.1%) patients, 375 (37.9%) patients had multimorbidity. Patients had mean 1.36 ± 1.32 comorbidity. The median durations of first biological DMARDs prescription were 60 (3–552) months after RA diagnosis. For multimorbidity patients, the median first biological prescription duration was longer than the duration for patients without multimorbidity (72 [3–552] vs 60 [3–396] months, P < .001). The physicians prescribe tumor necrosis factor inhibitor (TNFi) biological drugs less frequently than other biological DMARDs in patients with at least 1 comorbidity (66.2% vs 74.5%, P = .007) or multimorbidity (34.6% vs 43.5%, P = .006). Patients with comorbidities and multimorbidity achieved DAS-28 remission less frequently than patients without comorbidity (31.6% vs 42.6%, P = .012 and 27.2% vs 39.7%, P = .001, respectively).In real life, physicians may postpone to prescribe biological DMARDs and less frequently choose TNFi biological drugs in patients with multimorbidity. Furthermore, comorbidity may have a negative effect on the treatment response.

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“…[ 5 ] On the other hand, 2 prior studies encounter that more male patients frequently have more comorbidities among RA patients. [ 2 , 21 ] This conclusion is incompatible with our study.…”

Section: Discussioncontrasting

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Starting of biological disease modifying antirheumatic drugs may be postponed in rheumatoid arthritis patients with multimorbidity

et al. 2018

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“…5 Between 60% and 75% of those with RA are reported to have multimorbidity-two or more long-term conditions (LTCs)with higher number of LTCs reported with increasing age and disease activity. [6][7][8] Common comorbidities include cardiovascular conditions 9 such as coronary artery disease 10 and cardiac failure, 11 as well as mental health conditions such as depression. 12 Cardiovascular disease accounts for the majority of the excess mortality observed in RA, with raised inflammatory markers and shared risk factors implicated.…”

Section: Introductionmentioning

confidence: 99%

Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants

et al. 2020

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ObjectiveTo investigate how the type and number of long-term conditions (LTCs) impact on all-cause mortality and major adverse cardiovascular events (MACE) in people with rheumatoid arthritis (RA).DesignPopulation-based longitudinal cohort study.SettingUK Biobank.ParticipantsUK Biobank participants (n=502 533) aged between 37 and 73 years old.Primary outcome measuresPrimary outcome measures were risk of all-cause mortality and MACE.MethodsWe examined the relationship between LTC count and individual comorbid LTCs (n=42) on adverse clinical outcomes in participants with self-reported RA (n=5658). Risk of all-cause mortality and MACE were compared using Cox’s proportional hazard models adjusted for lifestyle factors (smoking, alcohol intake, physical activity), demographic factors (sex, age, socioeconomic status) and rheumatoid factor.Results75.7% of participants with RA had multimorbidity and these individuals were at increased risk of all-cause mortality and MACE. RA and >4 LTCs showed a threefold increased risk of all-cause mortality (HR 3.30, 95% CI 2.61 to 4.16), and MACE (HR 3.45, 95% CI 2.66 to 4.49) compared with those without LTCs. Of the comorbid LTCs studied, osteoporosis was most strongly associated with adverse outcomes in participants with RA compared with those without RA or LTCs: twofold increased risk of all-cause mortality (HR 2.20, 95% CI 1.55 to 3.12) and threefold increased risk of MACE (HR 3.17, 95% CI 2.27 to 4.64). These findings remained in a subset (n=3683) with RA diagnosis validated from clinical records or medication reports.ConclusionThose with RA and other LTCs, particularly comorbid osteoporosis, are at increased risk of adverse outcomes, although the role of corticosteroids could not be evaluated in this study. These results are clinically relevant for the monitoring and management of RA across the healthcare system, and future clinical guidelines for RA should acknowledge the importance of multimorbidity.

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“…Moreover, age >60 years increased the risk of hospitalization. This could be attributed to increased health‐related problems in this age group and increase in the number of comorbidities with age in RA patients …”

Section: Discussionmentioning

confidence: 99%

Influence of disease duration and socioeconomic factors on the prevalence of infection and hospitalization in rheumatoid arthritis: KRAC study

Chandrashekara¹,

Shobha

Dharmanand³

et al. 2019

Int J of Rheum Dis

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Aim: The use of healthcare resources by rheumatoid arthritis (RA) patients can be related to the presence of disease, comorbid conditions, use of steroids, and the combined use of immunosuppressants. This study evaluated the risk factors associated with infection and hospitalization in RA. Methods: This multicenter, cross-sectional study enrolled 3247 RA subjects fulfilling the 2010 American College of Rheumatology/European League Against Rheumatism criteria to examine the prevalence of hospitalization and episodes of documentable non-tubercular infections as a part of the "Karnataka rheumatoid arthritis comorbidity" study (KRAC). The study included 2081 subjects and 1166 were excluded due to incomplete data. Demographic, clinical and treatment variables were collected, and the events related to infections and hospitalization were extracted from the medical records. Comparative analysis and multivariate logistic regression were performed.Results: Around 22% of the subjects had hospitalizations and 2.9% had infections.Infections were pertaining to dental (1.3%), urinary tract (1.6%) and candidiasis (0.2%). Skin-and soft tissue-related infections were found in 1.8% and 0.3% of patients, respectively. Increased need of hospitalization in RA patients was associated with advanced age (≥60 years), lower education, family income, and longer duration of RA. Presence of comorbidity, usage of three or more disease-modifying anti-rheumatic drugs (DMARDs) and family income influenced the likelihood of infection.Dental infections were less likely in working subjects and more likely in patients with increased disease duration, higher family income, comorbidities and those between the age group 40-59 years. Urinary tract infection was associated with DMARD usage. Conclusion: Patient-specific risk factors should be considered to improve treatment strategies and to reduce the risk of infection and hospitalization in RA patients. | 1217 CHANDRASHEKARA Et Al. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Chandrashekara S, Shobha V, Dharmanand BG, et al. Influence of disease duration and socioeconomic factors on the prevalence of infection and hospitalization in rheumatoid arthritis: KRAC study. Int J Rheum

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Baseline comorbidities in patients with rheumatoid arthritis who have been prescribed biological therapy: A case control study

Cited by 18 publications

References 34 publications

Starting of biological disease modifying antirheumatic drugs may be postponed in rheumatoid arthritis patients with multimorbidity

Starting of biological disease modifying antirheumatic drugs may be postponed in rheumatoid arthritis patients with multimorbidity

Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants

Influence of disease duration and socioeconomic factors on the prevalence of infection and hospitalization in rheumatoid arthritis: KRAC study

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