Fri0025 does Comorbidity Impact on the Activity and Management of Rheumatoid Arthritis?

Abstract

Background:Patients with rheumatoid arthritis (RA) are in increased risk of developing comorbid conditions. Recent data suggest the relationship between severity of RA and concomitant diseases [1, 2]. Drug therapy is considered as impotent risk factor for numerous comorbidities. On the other hand comorbidity can impact negatively on the RA course and on the pts management [3].Objectives:The aim of our study was to evaluate the prevalence of concomitant conditions in RA pts, to compare the RA activity and management in relation with comorbidities.Methods:168 pts with established and longstanding RA were observed at in-patient clinic for RA clinical assessment and revealing concomitant diseases (cardiovascular, gastrointestinal, liver, pulmonary, endocrine, blood). The activity of disease according to DAS28-ESR index in RA subgroups with different comorbidities was compared. The spectrum and used doses of anti-rheumatic medications (DMARD, biologics, GC) in these subgroups was analyzed in term to assess the RA rational treatment.Results:The majority (88.1%) of observed RA pts had concomitant condition. The most frequent associated diseases were: cardiovascular (AH, IHD, HF, AF) in 86.9% and gastrointestinal (gastritis, duodenitis, gastroduodenal ulcer, colitis) in 64.3% less common comorbidities were anemia (30.9%), liver and kidney abnormalities (hepatomegaly, steatohepatitis, CKD, pyelonephritis) in 25% and 12.5% respectively, endocrine (type 2 diabetes mellitus, thyroid disorders) in 16.7%. Multimorbidity determined as combination of different system disorders in the setting of RA was detected in 54.8% of RA pts. We found out significant difference in RA activity on the basis of DAS28 between RA subgroup without concomitant conditions (the 1st) on the one hand and RA subgroups with comorbidities (the 2nd) (t1=2.76, p<0.01) or multimorbidities (t2=3.73, p<0.01) on the other hand (tab.1).IndexRA without comorbidities (1stgroup)RA with comorbidities(2nd group)RA with multimorbidities(3d group)DAS 284.20 ±0.315.09±0.095.44±0.12In RA with comorbidities/multimorbidities the mean doses of MTX and SSZ were lower than in RA without comorbidities, while the dose of GC and frequency of GC use was significantly higher in the 2nd and 3d groups (χ=4.25, 4.41 respectively). 55% of pts from the 1st group and only 19.6% of total amount of pts from the 2nd and 3d groups were treated with biologics (χ=5.67).Conclusion:Obtained data suggest that comorbidities have a negative impact on the severity of RA and can interfere in the implementation of T2T strategy in daily clinical practice.References:[1] Dougados M, Soubrier M, Antunez A, Balint P, Balsa A, Buch MH, et al. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis (2014) 73(1):62–8. doi:10.1136/annrheumdis-2013-204223[2] Radner H. Multimorbidity in rheumatic conditions. Wien Klin Wochenschr (2016) 128(21–22):786–90. doi:10.1007/s00508-016-1090-x[3] Radner H, Yoshida K,...