Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants

McQueenie, R., Nicholl, B. I. , Jani, B. D. , Canning, J., Macdonald, S. , McCowan, C. , Neary, J. , Browne, S. , Mair, F. S. and Siebert, S. (2020) Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants. BMJ Open, 10(11), e038829. (doi: 10.1136/bmjopen-2020-038829) (PMID:33234629) (PMCID:PMC7684828)

Abstract

OBJECTIVE:To investigate how the type and number of long-term conditions (LTCs) impact on all-cause mortality and major adverse cardiovascular events (MACE) in people with rheumatoid arthritis (RA). DESIGN:Population-based longitudinal cohort study. SETTING:UK Biobank. PARTICIPANTS:UK Biobank participants (n=502 533) aged between 37 and 73 years old. PRIMARY OUTCOME MEASURES:Primary outcome measures were risk of all-cause mortality and MACE. METHODS:We examined the relationship between LTC count and individual comorbid LTCs (n=42) on adverse clinical outcomes in participants with self-reported RA (n=5658). Risk of all-cause mortality and MACE were compared using Cox's proportional hazard models adjusted for lifestyle factors (smoking, alcohol intake, physical activity), demographic factors (sex, age, socioeconomic status) and rheumatoid factor. RESULTS:75.7% of participants with RA had multimorbidity and these individuals were at increased risk of all-cause mortality and MACE. RA and >4 LTCs showed a threefold increased risk of all-cause mortality (HR 3.30, 95% CI 2.61 to 4.16), and MACE (HR 3.45, 95% CI 2.66 to 4.49) compared with those without LTCs. Of the comorbid LTCs studied, osteoporosis was most strongly associated with adverse outcomes in participants with RA compared with those without RA or LTCs: twofold increased risk of all-cause mortality (HR 2.20, 95% CI 1.55 to 3.12) and threefold increased risk of MACE (HR 3.17, 95% CI 2.27 to 4.64). These findings remained in a subset (n=3683) with RA diagnosis validated from clinical records or medication reports. CONCLUSION:Those with RA and other LTCs, particularly comorbid osteoporosis, are at increased risk of adverse outcomes, although the role of corticosteroids could not be evaluated in this study. These results are clinically relevant for the monitoring and management of RA across the healthcare system, and future clinical guidelines for RA should acknowledge the importance of multimorbidity.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Jani, Dr Bhautesh and Mccowan, Professor Colin and Neary, Dr Joanne and Browne, Dr Susan and McQueenie, Dr Ross and Siebert, Professor Stefan and Mair, Professor Frances and Nicholl, Dr Barbara and Canning, Jordan and Macdonald, Professor Sara
• Authors: McQueenie, R., Nicholl, B. I., Jani, B. D., Canning, J., Macdonald, S., McCowan, C., Neary, J., Browne, S., Mair, F. S., and Siebert, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Infection & Immunity; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing; College of Social Sciences > School of Social and Political Sciences
• Research Centre: College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
• Journal Name: BMJ Open
• Publisher: BMJ Publishing Group
• ISSN: 2044-6055
• ISSN (Online): 2044-6055
• Published Online: 23 November 2020
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in BMJ Open 10(11):e038829
• Publisher Policy: Reproduced under a Creative Commons licence

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
301668		Multimorbidity in Arthritis and persistent musculoskeletal Pain (MAP) Study	Barbara Nicholl	Versus Arthritis (ARTRESUK)	Ref: 21970	HW - General Practice and Primary Care