Treating patients with RA must include management of comorbid conditions
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PHILADELPHIA — When analyzing patients with rheumatoid arthritis based on their comorbidities, certain groups experienced differing survival outcomes when compared with the expected mortality of the general population.
The findings from the retrospective, population-based study were presented at ACR Convergence 2022.
“This demonstrates certain comorbidity patterns are associated with poor prognosis, while patients with rheumatoid arthritis who have fewer comorbidities may not experience excess mortality compared to people without rheumatoid arthritis,” Cynthia Crowson, PhD, associate consultant II in the department of quantitative health sciences and professor of biostatistics and medicine in the division of rheumatology at the Mayo Clinic, told Healio.
The study included residents from eight Minnesota counties diagnosed with RA prevalence on January 1, 2015. Patients were identified from a comprehensive medical record linkage system. Starting 5 years prior to the prevalence date, the researchers collected diagnostic codes and defined 55 comorbidities using two codes at least 30 days apart. Patients were followed for vital status until death, last contact or the end of the study on December 31, 2021.
“Comorbidity patterns may hold the key to moving beyond a one-size-fits-all perspective of survival for patients with RA,” Crowson said.
The final analysis included 1,643 patients, of which 72% were female and 94% were white. The median age was 64 years, and the median duration of disease was 7 years. Crowson and colleagues identified comorbidities 94% (n = 1548) of patients, and found that 59% (n = 980) had five or more comorbidities.
“Patients with RA often have multiple additional comorbidities,” Crowson said. “The best outcomes will require optimal management of all comorbid conditions, not just RA.”
A latent cluster analysis was used to define four clusters of comorbidities. Cluster one had fewer comorbidities compared to the other clusters and included 686 patients who were younger, with a median age of 55 years, and were less likely to smoke. Mortality for this group was not increased compared with U.S. lifetables (standardize mortality ration [SMR] = 0.8; 95% CI, 0.55 - 1.1).
Cluster two included 200 patients with a median age of 60 years, high BMI and six or more comorbidities, according to the poster. For patients in cluster two, survival was poor (SMR = 1.6; 95% CI, 1.03 - 2.2). Cluster three included 623 patients with a median age of 72 years and three or more comorbidities that are also common in the general population, such as hypertension, hyperlipidemia and back problems. Survival was also poor in cluster three, but the researchers found it to be less pronounced (SMR = 1.2; 95% CI, 0.99 - 1.4).
Finally, cluster four included 134 older patients with a median age of 77 years. These patients were more likely to have smoked and had six or more comorbidities. Survival in this cluster was the worst (SMR = 3.5; 95% CI, 2.8 - 4.4), Crowson and colleagues reported.
“The association between comorbidity clusters and mortality highlights the importance of a patient-centric rather than disease-centric view of patient care,” Crowson said. “Even optimal treatment and management of RA may not improve outcomes when patients are also suffering from other comorbidities.”
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Crowson C, et al. Abstract 0246. Presented at: ACR Convergence 2022; November 11-14, 2022; Philadelphia (hybrid meeting).
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