Comorbidity problematic in inflammatory rheumatic diseases
medwireNews: People with inflammatory rheumatic diseases, particularly rheumatoid arthritis (RA) and psoriatic arthritis (PsA), have a higher comorbidity burden than people without these conditions, even in the early stages of the disease, researchers report.
Writing in RMD Open, Diederik De Cock (KU Leuven, Belgium) and co-authors suggest: “Rheumatologists should consider management of comorbidities as one of the primary tasks involved in the care of a newly diagnosed patient with an inflammatory rheumatic disease.”
They add: “Collaboration with other healthcare providers including nurses, primary care providers and other specialists is key to optimising a holistic management for every patient.”
De Cock and team used the Rheumatic Diseases Comorbidity Index (RDCI) to measure the overall comorbidity burden in patients newly diagnosed with RA (n=738), PsA (n=167), or spondyloarthritis (SpA; n=229). Each participant, identified from a Belgian general practitioner registry, was matched to four controls without RA or other musculoskeletal diseases.
At baseline, all three patient groups had similar median RDCI scores to their respective control groups.
However, by year 3, significantly more people with RA had an RDCI score of 1 or higher (on a scale of 0–9) than did the RA controls, at 66% versus 61%.
There was also a significant difference between the people with PsA and the PsA controls, with 61% and 48%, respectively, scoring 1 or more at year 3, but there was no significant difference between the people with SpA and the SpA controls (45 vs 41%).
When the researchers looked at the eight individual components of the RDCI (lung disease, cardiovascular disease, hypertension, fractures, depression, diabetes, digestive disease, and malignancies), they found that baseline prevalence was generally similar between patients and their controls for the three disease groups.
The only exception was that people with PsA had a significantly higher rate of depression at baseline than controls, at 20% versus 11%.
At 3 years, individual comorbidity rates were also broadly similar between patients and controls, but people with RA had a significantly higher incidence of cardiovascular disease, including myocardial infarction, than controls, at 24.32 versus 16.48 cases per 1000 person–years.
De Cock and team also report that medication use was substantially higher among the disease groups than controls. For example, 69–75% of patients received any pain medication versus 44–48% of controls, while polypharmacy rates were 41–61% versus 23–36%.
They investigators note that the “remarkably high opioid use in all populations” was of particular concern. Overall, 9% of the total study population was prescribed an opioid other than tramadol during the study period, with rates higher in patients (14–15%) than controls (6–9%).
De Cock et al conclude that their study “highlights the issue of multimorbidity in patients with musculoskeletal diseases, especially for individuals with RA and PsA.”
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