Examining the Relationship Between Rheumatoid Arthritis, Multimorbidity, and Adverse Health‐Related Outcomes: A Systematic Review

Abstract

Objective Multimorbidity (the coexistence of two or more long‐term conditions) is highly prevalent in people who have rheumatoid arthritis (RA). The present work systematically reviewed the literature to determine the effect of multimorbidity on all‐cause mortality, functional status, and quality of life in RA. Methods Six electronic databases were searched: CINAHL, The Cochrane Library, Embase, Medline, PsycINFO, and Scopus. Full‐text longitudinal observational studies in English were selected. Quality appraisal of studies was undertaken using the Cochrane‐developed QUIPS tool and a narrative synthesis of findings conducted. Results The search strategy identified 5,343 articles, with 19 studies meeting the inclusion criteria. Nine studies had mortality as an outcome, 9 reported functional status and/or quality of life, and 1 study reported both mortality and functional status. The number of participants ranged from 183 to 18,485, with studies conducted between 1985 and 2018. The mean age of participants ranged from 52.0 to 66.6 years, and 60.0–88.0% were female. Nine studies showed a significant association between multimorbidity and higher risk of mortality in people with RA. Ten studies reported significant associations between multimorbidity and reduced functional status in RA. Three studies also showed a further association with reduced quality of life. Only one study investigated the influence of mental health comorbidities on outcomes. Conclusion Our review findings indicate that multimorbidity is a significant predictor for higher mortality and poorer functional status/quality of life in people with RA and should be considered in clinical management plans.

Long-term mortality rates and associated risk factors following primary and revision knee arthroplasty

“…a systematic review has demonstrated an association between rheumatoid arthritis, multimorbidity, and increased all-cause mortality. 26 a registry-based cohort study from Denmark has similarly identified that compared to patients with oa, patients with rheumatoid arthritis had a greater risk of death within one year of primary hip and Ka. 27 these authors identified that glucocorticoid exposure and active inflammation significantly increased the risk of PJI and mortality in these patients.…”

Comprehensive assessment of multimorbidity burden in a population-based cohort of patients with rheumatoid arthritis

“…Multimorbidity is common in patients with rheumatoid arthritis (RA), and it is associated with increased mortality, poorer quality of life and increased healthcare utilisation 1 2. The concept of multimorbidity, which is patient-centric instead of focused on the index disease, is important for patients with RA due to the systemic nature of the disease 3.…”

Racial Differences in Multimorbidity and Comorbidities in Rheumatoid Arthritis

“…This finding held true even in subgroup analysis by age category, where having RA “aged” the youngest enrollees by 2–3 decades in terms of multimorbidity burden. This higher multimorbidity in all enrollees with RA is concerning, as multimorbidity is associated with worse functioning (12,25), reduced quality of life (12,26), and higher mortality (12,25). Although previous studies have also shown a >2‐fold increased risk of multimorbidity in RA patients (10), the relative lack of difference in multimorbidity burden by race and ethnicity was a novel finding of this study.…”

“…Multimorbidity, defined as presence of ≥2 comorbidities (10), also has a strong impact on RA outcomes. For example, multimorbidity lowers the likelihood of RA remission, reduces functional status, reduces quality of life, and increases mortality, compared to individuals without RA (11,12). In fact, multimorbidity accounts for most of the excess mortality in RA after RA diagnosis (13).…”