Prevalence and Impact of Inflammatory Multimorbid Conditions on Trajectories of Disease Activity in the First Year of Follow-up in a Multi-Center Era Cohort

Orit Schieir¹, Susan J. Bartlett², Carol Hitchon³, Janet E. Pope⁴, Gilles Boire⁵, Boulos Haraoui⁶, Edward C. Keystone⁷, Carter Thorne⁸, Diane Tin⁹ and Vivian P. Bykerk¹⁰, ¹McGill University, Montreal, ON, Canada, ²Department of Medicine, Division of ClinEpi, Rheumatology, Respirology, McGill University, Montreal, QC, Canada, ³University of Manitoba, Winnipeg, MB, Canada, ⁴University of Western Ontario, St Joseph's Health Care, London, ON, Canada, ⁵Rheumatology Division, CHUS - Sherbrooke University, Sherbrooke, QC, Canada, ⁶Institut de Rhumatologie de Montréal, Montreal, QC, Canada, ⁷Mount Sinai Hospital, Toronto, ON, Canada, ⁸University of Toronto and Southlake Regional Health Centre, Newmarket, ON, Canada, ⁹The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, ¹⁰Divison of Rheumatology, Hospital for Special Surgery, New York, NY

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Early Rheumatoid Arthritis and comorbidity

Session Information

Date: Monday, November 14, 2016

Title: Rheumatoid Arthritis – Clinical Aspects - Poster II: Co-morbidities and Complications

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Patients with rheumatoid arthritis also commonly report other chronic conditions (“multimorbidity”) with higher counts of conditions associated with reduced response to treatment and persistent disease activity. However little is known about which specific conditions have stronger associations with RA outcomes. The objective of the present study was to estimate the prevalence and impact of chronic inflammatory multimorbidity on the trajectory of disease activity in the first year in patients with early rheumatoid arthritis (ERA).

Methods: We analyzed data from ERA patients (<1-year symptom duration) enrolled in a large prospective multi-center cohort study who completed a standardized clinical assessment and self-report questionnaire every 3-months in the first year of follow-up, who met 1987 or 2010 ACR/EULAR RA criteria, and had at least two DAS28 measures available in the first year. Information on physician-diagnosed chronic inflammatory conditions including cardiovascular disease (CVD), pulmonary disease, bowel disease, diabetes, cancer, obesity, psoriasis and other rheumatologic conditions was obtained by patient self-report and information on depressive symptoms from SF-12 responses (using a depressive symptom cut-off of 42). Prevalence of each condition, as well as chronic inflammatory multimorbidity counts were estimated with standard descriptive statistics. Linear growth models were used to examine individual and cumulative effects of each chronic inflammatory condition on trajectory of DAS28 disease activity in the first year adjusting for age, sex, education, race, smoking, symptom duration, and treatment.

Results: The sample included 1595 patients with a mean(sd) age of 54(15) years, symptom duration of 6(3) months, 1153 (72%) were female and 1316 (83%) were white. At baseline 1434 (92%) were treated with a conventional DMARD (majority with methotrexate (76%)) and 33 (2%) with a biologic. Multimorbid inflammatory conditions were common: 1138 (72%) reported at least 1 condition, 541 (34%) reported at least 2 conditions and 166 (10%) reported 3 or more conditions. Depressive symptoms reported in 589 (40%), obesity in 355 (32%), pulmonary disease in 220 (14%), CVD in 191 (12%) and other rheumatic conditions in 197 (12%) were most prevalent, followed by diabetes 127 (8%) and cancer 109 (7%). Bowel disease in 61 (4%) and psoriasis in 60 (4%) were least prevalent. Results of multivariable growth models showed that depressive symptoms were associated with higher baseline disease activity and both depressive symptoms and obesity were associated with less change in DAS28 over time (p<0.05).

Conclusion: Results of the present study showed that multimorbidity with other chronic inflammatory conditions is common in ERA patients. Integrated treatment approaches to address multimorbid rather than single inflammatory conditions may yield better outcomes.

Disclosure: O. Schieir, None; S. J. Bartlett, None; C. Hitchon, None; J. E. Pope, Abbvie, 5,Actelion Pharmaceuticals US, 5,Amgen, 5,Bayer, 5,Bristol-Myers Squibb, 5,Genzyme Corporation, 5,Hospira, 5,Eli Lilly and Company, 5,Merck Pharmaceuticals, 5,Novartis Pharmaceutical Corporation, 5,Pfizer Inc, 5,Regeneron, 5,Roche Pharmaceuticals, 5,Sanofi-Aventis Pharmaceutical, 5,UCB, 5,Amgen, 2,Bristol-Myers Squibb, 2,Pfizer Inc, 2,Roche Pharmaceuticals, 2,UCB, 2; G. Boire, None; B. Haraoui, Abbott, Amgen, Bristol-Myers Squibb, Janssen, Pfizer, Roche, UCB Pharma, 2,Abbott, Amgen, Bristol-Myers Squibb, Janssen, Pfizer, Roche, UCB Pharma, 5,Abbott, Amgen, Bristol-Myers Squibb, Janssen, Pfizer, Roche, UCB Pharma, 8; E. C. Keystone, Abbott Laboratories, Astra Zeneca, BMS, Hoffmann-La Roche, Janssen, Lilly, Novartis, Pfizer, Sanofi-Aventis, UCB, 2,Abbott Laboratories, Astra Zeneca, Biotest, BMS, Crescendo Bioscience, Hoffmann-La Roche, Genentech, Janssen, Lilly, Merck, Pfizer, Samsung Bioepis, UCB, 5,Abbott Laboratories, Amgen, Astra Zeneca, BMS, Hoffmann-La Roche, Janssen, Lilly, Novartis, Pfizer, Sanofi-Aventis, UCB, 8; C. Thorne, Abbvie, Amgen, Celgene, Lilly, Novartis, Pfizer, Sanofi, and UCB, 2,Abbvie, Amgen, Celgene, Centocor, Genzyme, Hospira, Janssen, Lilly, Medexus/Medac, Merck, Novartis, Pfizer, Sanofi, and UCB, 5,Medexus/Medac, 8; D. Tin, None; V. P. Bykerk, AbbVie, Bristol-Myers Squibb, Pfizer, Genentech, Regeneron, UCB Pharma, 5.

To cite this abstract in AMA style:

Schieir O, Bartlett SJ, Hitchon C, Pope JE, Boire G, Haraoui B, Keystone EC, Thorne C, Tin D, Bykerk VP. Prevalence and Impact of Inflammatory Multimorbid Conditions on Trajectories of Disease Activity in the First Year of Follow-up in a Multi-Center Era Cohort [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/prevalence-and-impact-of-inflammatory-multimorbid-conditions-on-trajectories-of-disease-activity-in-the-first-year-of-follow-up-in-a-multi-center-era-cohort/. Accessed .

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