Presence of comorbidity affects both treatment strategies and outcomes in disease activity, physical function, and quality of life in patients with rheumatoid arthritis

Abstract

To clarify the impact of comorbidities on treatment strategies and outcomes in patients with rheumatoid arthritis (RA) using a large observational RA cohort, the presence of comorbidities was assessed using the Charlson Comorbidity Index (CCI). Changes in medication, disease activity by Disease Activity Score-28 joint count (DAS28) over 6 months, disability assessed by the Japanese version of the Health Assessment Questionnaire (J-HAQ), and quality of life by EuroQOL-5-Dimensions (EQ-5D) over 1 year in patients with high disease activity (DAS28 > 5.1) at baseline were assessed according to age-adjusted CCI (CCI(A)) and categorized into four groups (CCI(A) 0, 1-2, 3-4, and ≥5). Among 5,317 patients, 975 patients (18.3%) had at least one comorbidity listed by CCI. DAS28, J-HAQ, and EQ-5D increased in severity with increased CCI(A) levels. Among patients with high disease activity (n = 267), treatment with methotrexate and/or biologics and improved DAS28 scores, shown by attenuated intensity, were associated with increased CCI(A) levels. J-HAQ improved from 1.29 ± 0.31 to 0.87 ± 0.37 in 1 year in the CCI(A) 0 group. The adjusted difference (standard error) in J-HAQ at 1 year in CCI(A) 1-2, 3-4, and ≥5 groups was worse than J-HAQ in the CCI(A) 0 group by 0.32 (0.09, p < 0.001), 0.45 (0.10, p < 0.001), and 0.45 (0.15, p < 0.01), respectively. The magnitude of improvement of EQ-5D was significantly attenuated with increasing CCI(A) levels. Thus, patients with comorbidities may not experience the same degree of benefit from recent RA treatments compared with patients without comorbidities in daily practice.

Evaluation of quality of life in chronic, progressing rheumatic diseases based on the example of osteoarthritis and rheumatoid arthritis&nbsp;

“…Diagnosis of OA is made more often in the older age group, mainly between 55–65 years of age, whereas RA is diagnosed at an younger age (40–50 years) 5,7,10…”

“…The pain is usually most severe in the morning, and often occurs at night. It is accompanied by a feeling of morning stiffness of joints that lasts a few minutes, and in the active disease might last a few hours 10,19,20…”

“…RA is classified as a disease of connective tissue, which has a significant impact on the deteriorating of HRQoL, along with the duration of the disease 9,10…”

Actualización 2014 del Documento de Consenso de la Sociedad Española de Reumatología sobre el uso de terapias biológicas en la artritis reumatoide

“…La presencia de comorbilidad puede afectar tanto a la estrategia de los tratamientos como a los resultados de la eficacia (NE 2b) [160][161][162] . Actualmente no existen criterios específicos de indicaciones de biológicos para su uso en pacientes con comorbilidades importantes, por lo que esta condición hace que en muchos de estos pacientes, incluso con actividad alta o deterioro progresivo del daño estructural, se retrase el inicio de estas terapias.…”

Age and Comorbidities Influence Initial Treatment of Patients with Early Rheumatoid Arthritis

“…Later, Listing, et al evaluated the increased risk of infections in patients with RA associated with the disease per se, the comorbidities, and its treatment 4 . Recently, Nakajima, et al found that comorbidity affects both treatment strategies and outcomes in disease activity, physical function, and quality of life in patients with RA 5 . It is noteworthy that all studies have been conducted in patients with established RA, unlike our observation.…”