Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring in clinical practice: the spanish cohort of the COMORA study

Balsa, Alejandro; Oliveira, Leticia Lojo; Alperi-López, Mercedes; García-Manrique, M.; Ordóñez-Cañizares, Carmen; Pérez, Lorena; Ruíz-Esquide, Virginia; Corrales, Alfonso; Narváez, Javier; Rey-Rey, José; Rodríguez‐Lozano, Carlos; Ojeda, Soledad; Muñóz-Fernández, Santiago; Nolla, Joan M.; García-Torrón, José; Gamero, Fernando; García‐Vicuña, Rosario; Hernández‐Cruz, Blanca; Campos, José Luis López; Rosas, José; García-Llorente, José Francisco; Gómez-Centeno, Antonio; Cáliz, Rafael; Sanmartí, Raimón; Bermudez, Alberto Cruz; Abásolo-Alcazar, Lydia; Fernández‐Nebro, Antonio; Rodríguez‐Rodríguez, Luis; Marras, Carlos; González-Gay, Miguel Á.; Hmamouchi, Ihsane; Martı́n-Mola, Emilio

doi:10.1016/j.reuma.2017.06.002

Cited by 28 publications

(15 citation statements)

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“…In Brazil, three quarters of the population is served by this public and free system, with the others using various private and paid health plans [23] and the latter were likely not represented to a significant degree in this study. About 11% of REAL patients were currently smokers, a number lower than that published in previous RA studies from other parts of the world (25-33%), but consistent with the relatively low rates of smoking in the Brazilian population (females: 8.2% and males: 12.6%) [24][25][26][27]. Subsequent publications will explore the relationship of these differences with clinical and outcome variables.…”

Section: Discussionsupporting

confidence: 55%

The REAL study: a nationwide prospective study of rheumatoid arthritis in Brazil

et al. 2018

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Background: There are few data on the epidemiology, clinical manifestations and management of RA in Brazil, even with the recognition of the high direct, indirect and societal costs of this disease. Herein, we report the formation of the REAL -Rheumatoid Arthritis in Real Life, the first nationally representative multicenter prospective observational study in Brazil. Methods: The REAL study was designed to include a total of 1300 evaluable patients from 13 tertiary care public health centers specialized in RA management and representative of 5 regions of Brazil. Each center was expected to enroll~100 consecutively seen patients and follow them prospectively in a systematic protocol-driven fashion with scheduled visits at baseline, 6 and 12 months. Core clinical, laboratory and patient-reported outcomes measures were required to be collected at each visit. Results: A total of 1115 patients (89.4% female, mean age of 56.7 years and median disease duration of 12.7 years) were enrolled from 11 participating centers. Almost 80% of patients were of middle-low or low socioeconomic classes. The median educational time was 8 years, with 3.23% being below literacy level. The interval between symptoms and diagnosis varied from 1 to 457 months (median 12 months). Almost half of the patients were on glucocorticoids, 96.5% on DMARDs, with 35.7% on biologics. Median HAQ-DI was 0.875, ranging from 0 to 3. Median DAS28-ESR was 3.5, with 58.7% of patients presenting moderate or high disease activity. Conclusions:The first large cohort of Brazilian patients with RA in a real-life setting shows several striking differences from previously published cohorts from other countries. The long delay for diagnosis and start of DMARDs may partly explain the high frequency of erosive disease. An elevated percentage of patients on moderate or high disease activity was seen, despite of the high frequency of corticosteroid and biologics utilization. Data from this cohort may enable public health managers of developing countries better allocate the limited resources available for the care of RA patients.

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Section: Discussionsupporting

confidence: 55%

The REAL study: a nationwide prospective study of rheumatoid arthritis in Brazil

et al. 2018

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“…They quantified the increased risk for cardiovascular events (CVEs) and showed that the percentage of patients suffering a CVE and/or displaying subclinical atherosclerosis doubled within 12 months [ 3 ]. Another epidemiological study from Spain measured comorbidities in rheumatoid arthritis patients with a mean disease duration of 10 years and demonstrated a 51% prevalence of a Framingham Risk Score over 20%, resulting in a frequency of 5 and 1% of AMI and stroke, respectively [ 4 ▪ ].…”

Section: Introductionmentioning

confidence: 99%

Mechanisms of vascular comorbidity in autoimmune diseases

Nagy

Nemeth²,

Buzás

2018

Current Opinion in Rheumatology

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Purpose of reviewPersuasive statistics support the clinical observation that because of cardiovascular comorbidities patients with inflammatory joint disease die significantly earlier despite anti-inflammatory therapy.Recent findingsThe reason for this earlier death is multifactorial and involves a combination of a complex genetic background, environmental influences, classical cardiovascular risk factors and the impact of anti-inflammatory therapy. We will describe the importance of several new mechanisms, especially the diverse intercellular communication routes including extracellular vesicles and microRNAs that support the development of cardiovascular comorbidities.SummaryThe aim of this review is to give an updated overview about the known risk factors in the development of cardiovascular comorbidities with the latest insights about their mechanism of action. Furthermore, the impact of newly identified risk factors and significance will be discussed.

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“…While in 2002, screening for osteoporosis was infrequent in patients with RA and bone mineral density measurement was performed only in 10.8% 36 ; 12 years later in the COMORA study, bone density was performed in 36.6% of patients younger than 50 years and in 58.6% of those aged 50 years and older. 35 On the other hand, we know that in 2002 antiresorptive drugs were infrequently prescribed, and 9.4% of patients in the EMAR study received treatment with bisphosphonates. 36 Ten years later, in another study with the same design, EMAR2 study, 37 36.2% of patients received treatment with bisphosphonates.…”

Section: Discussionmentioning

confidence: 99%

“…And only over half of patients (55.2%) were supplemented with vitamin D during prednisone treatment, even in patients at high risk for osteoporosis. 35 …”

Section: Discussionmentioning

confidence: 99%

Trends in hip fracture in patients with rheumatoid arthritis: results from the Spanish National Inpatient Registry over a 17-year period (1999–2015). TREND-AR study

et al. 2018

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PurposeTo analyse trends in hip fracture (HF) rates in patients with rheumatoid arthritis (RA) over an extended time period (17 years).MethodsThis observational retrospective survey was performed by reviewing data from the National Surveillance System for Hospital Data, which includes more than 98% of Spanish hospitals. All hospitalisations of patients with RA and HF that were reported from 1999 to 2015 were analysed. Codes were selected using the Ninth International Classification of Diseases, Clinical Modification: ICD-9-CM: RA 714.0 to 714.9 and HF 820.0 to 820.3. The crude and age-adjusted incidence rate of HF was calculated by age and sex strata over the last 17 years. General lineal models were used to analyse trends.ResultsBetween 1999 and 2015, 6656 HFs occurred in patients with RA of all ages (84.25% women, mean age 77.5 and 15.75% men, mean age 76.37). The age-adjusted osteoporotic HF rate was 221.85/100 000 RA persons/ year (women 227.97; men 179.06). The HF incidence rate increased yearly by 3.1% (95% CI 2.1 to 4.0) during the 1999–2015 period (p<0.001) and was more pronounced in men (3.5% (95% CI 2.1 to 4.9)) than in women (3.1% (95% CI 2.3 to 4.1)). The female to male ratio decreased from 1.54 in 1999 to 1.14 in 2015. The average length of hospital stays (ALHS) decreased (p<0.001) from 16.76 days (SD 15.3) in 1999 to 10.78 days (SD 7.72) in 2015. Age at the time of hospitalisation increased (p<0.001) from 75.3 years (SD 9.33) in 1999 to 79.92 years (SD 9.47) in 2015. There was a total of 326 (4.9%) deaths during admission, 247 (4.4%) in women and 79 (7.5%) in men (p<0.001).ConclusionIn Spain, despite the advances that have taken place in controlling disease activity and in treating osteoporosis, the incidence rate of HF increased in both male and female patients with RA.

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Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring in clinical practice: the spanish cohort of the COMORA study

Cited by 28 publications

References 25 publications

The REAL study: a nationwide prospective study of rheumatoid arthritis in Brazil

The REAL study: a nationwide prospective study of rheumatoid arthritis in Brazil

Mechanisms of vascular comorbidity in autoimmune diseases

Trends in hip fracture in patients with rheumatoid arthritis: results from the Spanish National Inpatient Registry over a 17-year period (1999–2015). TREND-AR study

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