Comorbidity burden and clinical characteristics of patients with difficult-to-control rheumatoid arthritis.

Batko, B., Urbański, K., Świerkot, J., Wiland, P., Raciborski, F., Jędrzejewski, M., Koziej, M., Czesnikiewicz-Guzik, M. , Guzik, T. and Stajszczyk, M. (2019) Comorbidity burden and clinical characteristics of patients with difficult-to-control rheumatoid arthritis. Clinical Rheumatology, 38(9), pp. 2473-2481. (doi: 10.1007/s10067-019-04579-1) (PMID:31076943)

Abstract

Introduction: Difficult-to-treat rheumatoid arthritis (RA) is a significant clinical problem despite no clear definition. We aimed to provide clinical characteristics and associated comorbidities of RA patients in relation to disease control. Methods: RA characteristics and physician-recorded comorbidities were analyzed in a sample of 1937 RA patients. Patients treated for RA for 5.2 y (IQR, 2.1–11.3) were classified as difficult-to-control when presenting with DAS28-ESR > 3.2 despite previous use of at least 2 csDMARDs. A comparison of demographic and RA-related characteristics between difficult-to-treat and low disease activity patients (DAS28-ESR ≤ 3.2) was performed. Comorbidity burden was assessed by calculating Rheumatic Diseases Comorbidity Index (RDCI). Logistic regression model was constructed for difficult-to-control disease. Results: Hypertension (46.9% (95%CI, 44.7–49.2)), coronary artery disease (CAD) (18.5% (95%CI, 16.8–20.3)), and diabetes (14.4% (95%CI, 12.9–16.0)) were the most prevalent conditions in RA patients. When compared with the adequate control group, difficult-to-control patients were increasingly burdened with hypertension (52.7% (95%CI, 47.5–57.8) vs. 42.0% (95%CI, 36.6–47.6); p = 0.006), cardiovascular diseases (24.2% (95%CI, 20.1–28.9) vs. 11.1% (95%CI, 8.0–15.1); p < 0.001), respiratory system diseases (7.0% (95%CI, 4.8–10.2) vs. 3.3% (95%CI, 1.8–5.9); p = 0.03) and gastroduodenal ulcers (2.3% (95%CI, 1.2–4.4) vs. 0.3% (95%CI, 0.1–1.8); p = 0.04). Patients with higher RDCI had lower chance to obtain low disease activity (OR 0.69 (95%CI, 0.61–0.79); p < 0.001). In multivariate analysis, RDCI was independently associated with difficult-to-control disease (OR 1.46 (95%CI, 1.21–1.76); p < 0.001). Conclusions: RA patients suffer from a variety of comorbidities. Cardiovascular and respiratory system diseases occur twice as often in difficult-to-control patients. RDCI may provide a valuable tool in evaluating a risk for difficult-to-control RA.

• Item Type: Articles
• Additional Information: Funding: The study was supported by Roche.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Guzik, Professor Tomasz and Czesnikiewicz-Guzik, Dr Marta
• Authors: Batko, B., Urbański, K., Świerkot, J., Wiland, P., Raciborski, F., Jędrzejewski, M., Koziej, M., Czesnikiewicz-Guzik, M., Guzik, T., and Stajszczyk, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
• Journal Name: Clinical Rheumatology
• Publisher: Springer London
• ISSN: 0770-3198
• ISSN (Online): 1434-9949
• Published Online: 10 May 2019