Comprehensive assessment of multimorbidity burden in a population-based cohort of patients with rheumatoid arthritis

• Published in: Rheumatic & musculoskeletal diseases open Vol. 8; no. 1; p. e002022
• Main Authors: Crowson, Cynthia S, Gunderson, Tina M, Dykhoff, Hayley J, Myasoedova, Elena, Atkinson, Elizabeth J, Kronzer, Vanessa L, Coffey, Caitrin M, Davis III, John M
• Format: Journal Article
• Language: English
• Published: England EULAR 01.01.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Age groups; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - epidemiology; Body mass index; cardiovascular diseases; Codes; Cohort Studies; Comorbidity; Disease; epidemiology; Female; Humans; Male; Medical records; Middle Aged; Morbidity; Multimorbidity; Osteoarthritis - epidemiology; Patients; Prevalence; Rheumatoid Arthritis; United Kingdom > UK; England; epidemiology; rheumatoid arthritis; cardiovascular diseases
• ISSN: 2056-5933; 2056-5933
• DOI: 10.1136/rmdopen-2021-002022

ObjectiveTo comprehensively assess multimorbidity burden in patients with rheumatoid arthritis (RA) in order to unify the multimorbidity definition for RA research and clinical practice.MethodsIn this population-based study, residents of eight Minnesota counties with prevalent RA on 1 January 2015 were identified. Age, sex and county-matched non-RA comparators were selected from the same population. Diagnostic codes were retrieved for 5 years before 1 January 2015. Using two codes ≥30 days apart, 44 previously defined morbidities and 78 non-overlapping chronic disease categories based on Clinical Classification Software were defined. Prevalence of each morbidity in the RA versus non-RA cohorts was compared using false discovery rate to adjust for multiple comparisons. Morbidities more common in RA than non-RA and those with prevalence ≥5% were retained.Results1643 patients with RA and 1643 non-RA subjects (72% women; mean age 63.1 years) were studied. Using the 44 morbidities, multimorbidity (defined as 2+ morbidities) was present in 1411 (86%) of RA and 1164 (71%) of non-RA subjects (p<0.001) with 5+ morbidities present in 907 (55%) of RA and 619 (38%) of non-RA (p<0.001). Patients with RA had significantly higher prevalence of 24 of the 44 morbidities compared with non-RA, especially interstitial lung disease, fibromyalgia, osteoarthritis and osteoporosis. Among the additional 78 categories, 7 were significantly higher in RA than non-RA, including organic sleep disorders, vitamin D deficiency and foot ulcers.ConclusionPatients with RA have a higher prevalence of multimorbidity compared with non-RA subjects. These results confirm the list of 44 morbidities and add several other morbidities of interest in RA.