Session Information
Date: Sunday, October 21, 2018
Title: 3S086 ACR Abstract: RA–DX, Manifestations, & Outcomes I: Other Co-Morbidities (880–885)
Session Type: ACR Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: Racial/ethnic disparities in comorbidity (CM) in rheumatoid arthritis (RA) may confound treatment and outcomes. Rheumatic Disease Comorbidity Index (RDCI) is a validated tool predicting disability and mortality in RA patients. We evaluated the association between RDCI and clinical outcomes within racial/ethnic subsets of RA patients
Methods: Patients enrolled in the Ethnic Minority RA Consortium (EMRAC), with at least one follow-up (FU) visit were analysed. RDCI was compiled from enrolment data. Clinical outcomes: tender joint count (TJC), swollen joint count (SJC), RAPID3 and DAS28; medication use (recorded and aggregated as prednisone methotrexate, other DMARD, and biologic use), were recorded. Analysis of variance or chi-square tests were used to estimate enrolment differences between racial/ethnic groups. Generalized estimating equations and mixed model regression accounting for repeated measurements were used to estimate any differences between racial/ethnic groups during FU, and explore associations of RDCI on clinical outcomes and remission (DAS28<2.6), adjusting for enrolment age, gender, education, race/ethnicity and medication use.
Results: 1066 subjects with 3719 FU visits over 58 weeks were evaluated. Racial/ethnic disparities were seen in formal education, RAPID3, DAS28, TJC, SJC as well as CM. Additionally, racial/ethnic disparities were seen in length of FU and medication use (Table). Increased RDCI scores were significantly associated with increased enrolment RAPID3 (P=0.022) and DAS28 (P<0.001), adjusting for age, education, gender and race/ethnicity. Enrolment DAS28 was also significantly higher in Blacks (0.49, 95% CI [0.21, 0.78], P=0.001) and Hispanics (0.70, 95% CI [0.37, 1.03], P=0.001) compared to Whites. While increased RDCI significantly reduced improvement in both RAPID3 (P<0.001) and DAS28 (P<0.001), RDCI was not significantly associated with reducing odds of DAS28 remission. Blacks, however, were significantly less likely to have DAS28 remission than all other race groups (Figure). Additionally, biologic use increased odds of DAS28 remission (OR=1.53, 95% CI [1.01, 2.33], P=0.45), but was less with advanced age (OR=0.80, 95% CI [0.68, 0.95], P=0.009).
Conclusion: CM was associated with higher disease activity regardless of race/ethnicity or medication, with black patients having more CM and less odds of remission. Early access to care for management of comorbidities and disease in Black RA patients is necessary to improve outcomes
.
|
Table. Enrolment and Follow-up Data by Racial / Ethnicity Groups |
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|
White
|
Black
|
Hispanic
|
Other
|
Total
|
P
|
|
|
N
|
380
|
258
|
161
|
267
|
1066
|
|
|
Enrolment
|
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|
Age (years)
|
55.53 (15.62)
|
56.66 (14.45)
|
54.48 (13.48)
|
54.01 (16.32)
|
55.27 (15.23)
|
0.214
|
|
Education (years)
|
15.07 (3.12)
|
13.42 (3.22)
|
12.61 (4.44)
|
15.23 (3.47)
|
14.25 (3.59)
|
<0.001
|
|
Female [N(%)]
|
296 (78.1%)
|
213 (82.6%)
|
129 (80.1%)
|
221 (86.0%)
|
859 (81.4%)
|
0.082
|
|
Tender Joints [0-28]
|
1.05 (3.62)
|
2.51 (5.02)
|
2.32 (4.91)
|
0.50 (2.37)
|
1.46 (4.06)
|
<0.001
|
|
Swollen Joints [0-28]
|
0.49 (2.04)
|
2.00 (3.82)
|
1.68 (3.85)
|
0.33 (1.76)
|
1.00 (2.92)
|
<0.001
|
|
RAPID3 [0-30]
|
11.33 (7.21)
|
13.07 (7.10)
|
12.68 (7.65)
|
10.83 (7.50)
|
11.95 (7.34)
|
<0.001
|
|
DAS28 [0-10]
|
2.32 (1.28)
|
3.11 (1.26)
|
3.09 (1.52)
|
2.41 (1.16)
|
2.28 (1.10)
|
<0.001
|
|
RDCI > 0 [N(%)]
|
95 (25.0%)
|
116 (45.0%)
|
48 (29.8%)
|
63 (23.6%)
|
322 (30.2%)
|
<0.001
|
|
Follow-up*
|
||||||
|
Number of Visits
|
1368
|
1033
|
514
|
804
|
3719
|
|
|
Length (weeks)
|
49.34 (46.59)
|
84.57 (71.77)
|
43.07 (46.58)
|
48.04 (50.25)
|
57.98 (57.87)
|
<0.001
|
|
Change RAPID3
|
1.54 (6.56)
|
0.71 (6.23)
|
2.37 (6.51)
|
1.06 (7.12)
|
1.29 (6.54)
|
<0.001
|
|
Change DAS28
|
0.34 (1.18)
|
0.03 (1.09)
|
0.80 (1.18)
|
0.37 (1.09)
|
0.34 (1.09)
|
<0.001
|
|
Prednisone Use [N(%)]
|
312 (22.8%)
|
216 (20.9%)
|
187 (36.4%)
|
225 (28.0%)
|
940 (25.3%)
|
0.030
|
|
Methotrexate Use [N(%)]
|
641 (46.9%)
|
342 (33.1%)
|
254 (49.4%)
|
456 (56.7%)
|
1693 (45.5%)
|
<0.001
|
|
Other DMARD Use [N(%)]
|
298 (21.8%)
|
213 (20.6%)
|
135 (26.3%)
|
215 (26.7%)
|
861 (23.2%)
|
<0.001
|
|
Biologic Use [N(%)]
|
572 (41.8%)
|
188 (18.2%)
|
136 (26.5%)
|
265 (33.0%)
|
1161 (31.2%)
|
<0.001
|
|
*All follow-up visit differences between racial/ethnic groups were estimated using generalized estimating equations.
|
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To cite this abstract in AMA style:
Dowell S, Perez-Alamino R, Swearingen CJ, Kerr GS, Yazici Y. Association of Comorbidities with DAS28 Disease Status and Remission in Race/Ethnic Groups with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/association-of-comorbidities-with-das28-disease-status-and-remission-in-race-ethnic-groups-with-rheumatoid-arthritis/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-comorbidities-with-das28-disease-status-and-remission-in-race-ethnic-groups-with-rheumatoid-arthritis/