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21-11-2019 | Rheumatoid arthritis | News

RA comorbidities signal a need to screen

medwireNews: US researchers have identified a number of chronic conditions associated with rheumatoid arthritis (RA), including some that may predispose to RA development and others that may arise as a result of RA.

Those thought to be associated with the development of RA include autoimmune diseases and epilepsy, whereas heart disease, venous thromboembolism (VTE), and obstructive sleep apnea (OSA) tend to develop following an RA diagnosis.

Vanessa Kronzer (Mayo Clinic, Rochester, Minnesota) and colleagues say their findings “have important implications for understanding RA pathogenesis, promoting earlier detection of RA, and screening for comorbidities among RA patients.”

The study included 821 people with RA and 2455 age- and sex-matched controls without RA who provided details of comorbidities to the Mayo Clinic Biobank between 2009 and 2018.

At baseline, 11 of the 74 comorbidities screened for were significantly more common in patients with RA than in controls, after adjustment for race, body mass index, education, smoking, comorbidity, and multiple comparisons.

These were pulmonary fibrosis (odds ratio [OR]=4.63), systemic lupus erythematosus or scleroderma (OR=4.44), fibromyalgia (OR=2.67), inflammatory bowel disease (OR=2.63), myocardial infarction (OR=2.15), epilepsy (OR=2.13), venous thromboembolism (VTE; OR=1.85), osteoarthritis (OR=1.70), OSA (OR=1.44), gastroesophageal reflux disease (OR=1.47), and cataracts (OR=1.38).

By contrast there was no significant difference in the rate of cancer between the people with RA and controls either overall or in any of the 21 individual cancers included.

Kronzer and team identified four comorbidities that were significantly more common in the period before RA diagnosis in the patients who developed RA relative to controls: inflammatory bowel disease (OR=3.82), type 1 diabetes (OR=3.07), VTE (OR=1.80), and osteoarthritis (OR=1.54).

VTE (OR=1.84) also occurred more often in RA patients after diagnosis compared with controls as did myocardial infarction (OR=3.09), and there was a trend toward a higher likelihood of developing OSA in RA cases relative to controls after diagnosis.

In a statement to the press, Kronzer said: “Our findings suggest that people with certain conditions, such as [t]ype 1 diabetes or inflammatory bowel disease, should be carefully monitored for rheumatoid arthritis.

“In addition, people who have rheumatoid arthritis, and their health care providers, should have heightened suspicion and a low threshold to screen for cardiovascular disease, blood clots and sleep apnea.”

The researchers conclude in Mayo Clinic Proceedings that “[f]uture studies should investigate why the observed overlap between RA and these comorbidities occurs and then examine whether heightened screening for RA and its comorbidities leads to improved outcomes.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Mayo Clin Proc 2019; doi:10.1016/j.mayocp.2019.08.010

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