Background/Purpose:

Patients with rheumatoid arthritis (RA) suffer from comorbidities that contribute to a shortened lifespan. The degree of inflammation is of importance for the development of cardiovascular disease, but little is known on its relationship with other comorbidities in RA. In the present prospective study we examined the prevalence of comorbidities in early RA and the role of inflammation in this context.

Methods:

All patients with early RA (symptom duration <12 months) in Northern Sweden are since 1995 included in a study on co-morbidities. By now 950 patients have been included.  At the time of this compilation, 715 patients were followed-up of whom 498 had been ill for ≥ 5 years. Data on comorbidities, disease activity, x-ray (hands, feet) and laboratory samples (autoantibodies, inflammatory variables) and pharmacological therapy were collected in record studies and validated using a survey at RA onset (T0) and after 5 years of disease (T5).

Results:

56% had one or more comorbidities at RA onset. After 5 years, 44% developed at least one new comorbidity. At T0, the most common comorbidities were: hypertension (26.7%), obstructive pulmonary disease (13.4%), diabetes (7.1%), hypothyroidism (7.0%) and malignancy (5.2%). At T5, the most common new comorbidities during the first five years of RA were: hypertension (14.3%), malignancy (7.6%), stroke/TIA (5.0%), myocardial infarction (4.8%) and osteoporosis (4.4%). Univariate regression analyses showed that age (p< 0.001), ESR (p< 0.01), extra-articular RA, Larsen score and corticosteroids (p<0.05 for all) were associated with a new comorbidity during 5 years. Female gender and biologics reduced the risk of comorbidity (p<0, 05 for both). In a regression model adjusted for sex, age, corticosteroid treatment and smoking, extra- articular RA was associated with new endocrine disease during 5 years. In another model, adjusted for age, sex and smoking, AUC for DAS28 (24 months) was associated with lung disease ever.

Conclusion:

There is substantial comorbidity among RA patients already at disease onset and considerable new comorbidity during the first five years of disease. Measures of disease activity were associated with occurrence of comorbidity.

Reference: Innala L et al. Cardiovascular events in early RA are a result of inflammatory burden and  traditional risk factors: a five year prospective study. Arthritis Res Ther 2011, 13:R131.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comorbidity-in-early-rheumatoid-arthritis-does-inflammation-matter/