Multimorbidity 'highly prevalent,' progresses more rapidly in RA
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Multimorbidity is highly prevalent, and progresses more rapidly, among patients with rheumatoid arthritis compared to those without the disease, according to data published in the Annals of the Rheumatic Diseases.
“Multimorbidity is a growing public health problem related to the rising prevalence of chronic diseases,” Bryant R. England, MD, PhD, of the University of Nebraska Medical Center, told Healio Rheumatology. “While prior research has highlighted some of the chronic conditions that can occur in patients with rheumatoid arthritis, there was an incomplete understanding of the timing of onset and rate of accumulating greater multimorbidity in RA.”
To analyze multimorbidity among individuals with and without RA, England and colleagues conducted a matched, retrospective cohort study of data within the Truven MarketScan commercial claims and encounters database. Focusing on data from Jan. 1, 2006, to Sept. 30, 2015, the researchers identified an overall RA cohort of 277,782 individuals and an incident RA cohort of 61,124. All patients were matched 1:1 based on age and sex to individuals without RA.
The researchers selected diagnostic codes for 44 preidentified chronic conditions to characterize the presence — defined as two or more conditions — and burden — based on count — of multimorbidity. England and colleagues performed cross-sectional comparisons using the overall RA cohort and conditional logistic and negative binomial regression models. Meanwhile, the incident RA cohort was used to assess trajectories of multimorbidity, via generalized estimating equations.
According to the researchers, the cross-sectional prevalence (OR = 2.29; 95% CI, 2.25-2.34) and burden (ratio of conditions = 1.68; 95% CI, 1.66-1.7) of multimorbidity were significantly higher among those with RA, compared with those without, in the overall cohort. In the incident cohort, those with RA demonstrated more chronic conditions than those without ( = 1.13; 95% CI, 1.1-1.17). Additionally, the rate with which individuals in the incident cohort accrued chronic conditions was significantly higher among those with RA, compared those without (P < .001).
Data from the pre-RA period, as well as several sensitivity analyses, produced similar results, the researchers wrote.
“The prevalence and burden of multimorbidity is significantly higher in RA than in the general population,” England said. “This heightened burden appears to start as RA is developing and then increases at a faster rate following RA diagnosis compared to the general population.”
“Multimorbidity is accompanied by many poor long-term outcomes,” he added. “Since we know that patients with RA have high rates and burden of multimorbidity that starts early in the disease course, we need to implement broader management strategies that go beyond just treating the joints in order to ensure optimal long-term outcomes for our patients.”
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