For rheumatologists managing patients with RA, it’s natural to focus most closely on RA and its direct impacts. However, 60% of patients with RA have 3 or more comorbidities, compared with 37% of matched individuals without RA.1 Multimorbidity is relatively common among patients with RA, and consequently we are seeing many abstracts on multimorbidity at the upcoming virtual ACR Convergence 2020.
Multimorbid patients living with RA have numerous challenges, including:
- Reduced likelihood of achieving remission2
- Decreased quality of life3
- Increased healthcare costs1
- Increase in all-cause mortality4
For this reason, guidelines from ACR, EULAR, and other organisations stress the importance of regular health screenings for other health conditions5-7 in patients living with RA, and specific recommendations exist for key comorbidities in patients with RA, such as1,5-7:
- Cardiovascular diseases (CVD)
- Infection risk
- Physiological health
- Respiratory health
Studies have shown that not only are these the most common comorbid conditions, but also that patients living with RA are at significantly increased risk for developing them.8-12 For example, RA reduces cardiac and endothelial function, alters lipid metabolism and lipoprotein composition, and enhances atherogenesis, all of which can contribute to the 50% higher riska for CVD in patients living with RA.8,13
The impacts of comorbidities in patients living with RA are particularly important to keep in mind while treating these patients during the COVID-19 pandemic.14 Pre-existing respiratory illness, CVD, and diabetes have been shown to increase the likelihood of a patient living with RA being admitted to the hospital with COVID-19.15 These findings only further emphasise the importance of considering comorbidities in the management of patients with RA.
aPooled relative risk based on 14 studies comprising 41,490 patients with RA (pooled RR: 1.48, 95% CI [1.36 to 1.62])
Read Dr. Bernard Combe’s perspectives on the impact of comorbidities in patients with RA.
ACR, American College of Rheumatology; EULAR, European League Against Rheumatism; RA, rheumatoid arthritis.
References: 5. An J, et al. Clin Rheumatol. 2019;38(10):2717-2726. 6. Ranganath VK, Maranian P, Elashoff DA, et al. Rheumatology. 2013;52(10):1809-1817. 7. Michaud K, Wolfe F. Best Pract Res Clin Rheumatol. 2007;21(5):885-906. 8. Nikiphorou E, de Lusignan S, Mallen C, et al. Rheumatology (Oxford). 2020;59(6):1296-1305. 9. Baillet A, Gossec L, Carmona L, et al. Ann Rheum Dis. 2016;75(6):965-973. 10. Singh JA, Saag KG, Bridges SL Jr, et al. Arthritis Rheumatol. 2016;68(1):1-26. 11. Lau CS, Chia F, Harrison A, et al. Int J Rheum Dis. 2015;18(7):685-713. 12. Avina-Zubieta JA, Tomas J, Sadatsafavi M, Lehman AJ, Lacaille D. Ann Rheum Dis. 2012;71(9):1524-1529. 13. Shaw M, Collins BF, Ho LA, Raghu G. Eur Respir Rev. 2015;24(135):1-16. 14. Solomon DH, Kremer J, Curtis JR, et al. Ann Rheum Dis. 2010;69(11):1920-1925. 15. Doran MF, et al. Arthritis Rheum. 2002;46(9):2287-2293. 16. Margaretten M, Julian L, Katz P, Yelin E. Int J Clin Rheumatol. 2011;6(6):617-623. 17. England BR, Thiele GM, Anderson DR, Mikuls TR. BMJ. 2018;361:k1036. 18. Roongta R, Ghosh A. Clin Rheumatol. 2020:39:3237-3244. 19. Gianfrancesco M, Hyrich KL, Al‑adely S, et al. Ann Rheum Dis. 2020;79:859-866.