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29-10-2020 | Rheumatoid arthritis | News

Excess multimorbidity begins early in RA disease course

Author: Laura Cowen


medwireNews: Multimorbidity is more common in people with versus without rheumatoid arthritis (RA), occurs early in the disease course, and progresses more rapidly, US study data show.

Bryant England (University of Nebraska Medical Center, Omaha) and co-investigators say: “Multimorbidity should be targeted early in the RA disease course to prevent progression and achieve better long-term patient outcomes.”

Using commercial insurance data collected between 2006 and 2015, England and team found that 33.9% of 138,891 individuals (76.5% women, mean age 55.6 years) with RA had multimorbidity, defined as two or more of 44 chronic conditions (excluding RA) selected on the basis of their prevalence and importance in the general population and in people with RA.

By comparison, the multimorbidity rate was 21.1% among the same number of matched controls without RA, and the odds for multimorbidity were a significant 2.29-fold higher with versus without RA.

The researchers observed that 39 of the 44 chronic conditions assessed were significantly over-represented in the RA cohort, with the highest odds ratios (ORs) observed for interstitial lung disease (OR=12.62), fibromyalgia (OR=5.86), osteoarthritis (OR=5.16), and osteoporosis (OR=4.54).

England and team also report that the mean multimorbidity burden, indicated by the number of chronic conditions, was a significant 1.68-fold higher in the people with RA relative to those without, at 1.47 versus 0.88.

Furthermore, the researchers note in the Annals of the Rheumatic Diseases that by not including RA in the definition of multimorbidity, their “results underestimate the true prevalence and burden of multimorbidity affecting patients with RA.”

In the subgroup of 30,562 individuals with incident RA and their 30,562 matched controls, trajectory analyses showed that patients with RA had significantly more chronic conditions at diagnosis and a significantly higher rate of accruing chronic conditions over time than those without RA, with the differences persisting when conditions closely related to RA or that may be misclassified as RA were removed.

England et al conclude: “Our findings shed important light on the natural history of multimorbidity and will help inform the future development of preventive and/ or therapeutic interventions aimed at reducing multimorbidity burden in this high-risk population.”

They add that the data highlight “the need for the early RA period to also include aggressive screening for, and management of, multimorbidity.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group

Ann Rheum Dis 2020; doi:10.1136/annrheumdis-2020-218282