Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA)

Abstract

BackgroundPatients with rheumatoid arthritis (RA) are at increased risk of developing comorbid conditions.ObjectivesTo evaluate the prevalence of comorbidities and compare their management in RA patients from different countries worldwide.MethodsStudy design: international, cross-sectional. Patients: consecutive RA patients. Data collected: demographics, disease characteristics (activity, severity, treatment), comorbidities (cardiovascular, infections, cancer, gastrointestinal, pulmonary, osteoporosis and psychiatric disorders).ResultsOf 4586 patients recruited in 17 participating countries, 3920 were analysed (age, 56±13 years; disease duration, 10±9 years (mean±SD); female gender, 82%; DAS28 (Disease Activity Score using 28 joints)–erythrocyte sedimentation rate, 3.7±1.6 (mean±SD); Health Assessment Questionnaire, 1.0±0.7 (mean±SD); past or current methotrexate use, 89%; past or current use of biological agents, 39%. The most frequently associated diseases (past or current) were: depression, 15%; asthma, 6.6%; cardiovascular events (myocardial infarction, stroke), 6%; solid malignancies (excluding basal cell carcinoma), 4.5%; chronic obstructive pulmonary disease, 3.5%. High intercountry variability was observed for both the prevalence of comorbidities and the proportion of subjects complying with recommendations for preventing and managing comorbidities. The systematic evaluation of comorbidities in this study detected abnormalities in vital signs, such as elevated blood pressure in 11.2%, and identified conditions that manifest as laboratory test abnormalities, such as hyperglycaemia in 3.3% and hyperlipidaemia in 8.3%.ConclusionsAmong RA patients, there is a high prevalence of comorbidities and their risk factors. In this multinational sample, variability among countries was wide, not only in prevalence but also in compliance with recommendations for preventing and managing these comorbidities. Systematic measurement of vital signs and laboratory testing detects otherwise unrecognised comorbid conditions.

Factors influencing the choice of first- and second-line biologic therapy for the treatment of rheumatoid arthritis: real-life data from the Italian LORHEN Registry

“…The prevalence of comorbidities in our study was generally in line with previous epidemiologic reports [25]; however, we demonstrated that the number and the type of comorbidity Fig. 3 Multinomial logistic regression analyzing the factors associated with the choice of a specific first-line (a) or second-line (b) bDMARD (ABA or TCZ) compared to TNFi differ among the three different therapeutic agents and may influence the choice of bDMARD treatment.…”

“…Interestingly, after 5 years, up to 41% of patients developed at least one new comorbidity, mainly cardiovascular, neoplastic, or osteoporosis. The high prevalence of comorbid conditions in patients with RA has been confirmed by a number of studies, among which, the COMOrbidities in Rheumatoid Arthritis (COMORA) study [25], a large international, cross-sectional study recruiting 4586 patients, highlighted the high prevalence of comorbidities and related risk factors in patients with RA and the need for an optimization of treatment.…”

A therapeutic role for potassium (K) to reduce pain and complications related to the cardiovascular system and bone in rheumatoid arthritis (RA): A clinical research perspective

“…Several population-based studies have validated the benefits of a K-rich diet and K supplementation in the prevention and treatment of hypertension [79][80][81][82]. Though the exact mechanism is not known, several experimental studies have demonstrated the inhibitory effects of serum K on vascular smooth muscle proliferation, reducing macrophage adherence to the vascular wall, arterial thrombosis, free oxygen radicals, and reactive oxygen species [83][84][85]. K ions are also released by the endothelial cells in response to neuro-humoral mediators (sympatheticadrenal and cortisol related mechanisms) and physical forces (such as shear stress) and contribute to endothelium-dependent relaxations.…”

Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process

“…Despite general recognition that patients with RA are at increased risk of CVD events, there is ample evidence that even well established CVD risk factors such as hypertension and dyslipidemia are not identified and managed consistently in RA populations (6)(7)(8)(9)(10)(11)(12)(13)(14)(15). One strategy to reduce CVD risk in RA is therefore to better identify and manage modifiable risk factors such as smoking, hypertension, obesity and dyslipidemia.…”