Risk factors for hospitalizations in a large, contemporary rheumatoid arthritis patient cohort

Argyro Lazarini¹, Konstantinos Thomas², EVRIPIDIS KALTSONOUDIS³, Paraskevi V Voulgari⁴, Alexandros Drosos⁵, Argyro Repa⁶, Ainour Molla ismail Sali⁶, Prodromos Sidiropoulos⁶, Kalliopi Fragkiadaki¹, Maria Tektonidou⁷, Petros Sfikakis⁸, Panagiota Tsatsani⁹, Sousana Gazi⁹, Evangelia Argyriou¹⁰, Kyriaki Boki¹⁰, Pelagia Katsimpri¹, Dimitrios Boumpas¹, Gerasimos Evangelatos¹¹, Alexios Iliopoulos¹², Konstantina Karagianni¹³, Lazaros Sakkas¹³, Konstantinos Melissaropoulos¹⁴, Panagiotis Georgiou¹⁴, Eleftheria Grika¹, PANAYIOTIS VLACHOYIANNOPOULOS¹, Theodoros Dimitroulas¹⁵, Alexandros Garyfallos¹⁶, Konstantinos Georganas¹⁷, Periklis Vounotrypidis¹⁸, Konstantinos Ntellis¹⁹, Georgios Kitas²⁰ and Dimitrios Vassilopoulos²¹, ¹Joint Rheumatology Program, University of Athens Medical School, Athens, Greece, ²Joint Rheumatology Program, University of Athens Medical School, Athens, Greece, ³Rheumatology Clinic, University of Ioannina, IOANNINA, Ioannina, Greece, ⁴Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Ioannina, Greece, ⁵Rheumatology Clinic, University of Ioannina, Ioannina, Greece, ⁶Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece, ⁷National and Kapodistrian University of Athens, Athens, Greece, ⁸NKUA - SCHOOL OF MEDICINE, Athens, Greece, ⁹Rheumatology Unit, KAT Hospital, Athens, Greece, ¹⁰Rheumatology Unit, Sismanoglio Hospital, Athens, Greece, ¹¹Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Attiki, Greece, ¹²⁴¹⁷ Army Share Fund Hospital (NIMTS), Department of Rheumatology, Athens, Greece, ZOGRAFOU, Greece, ¹³Department of Rheumatology, University of Thessaly, Larissa, Greece, ¹⁴Rheumatology Unit, Agios Andreas Hospital, Patras, Greece, ¹⁵Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Fourth Department of Internal Medicine, Thessaloniki, Greece, Thessaloniki, Greece, ¹⁶⁴th Department of Medicine, Aristotle University, Thessaloniki, Greece, ¹⁷Private office, Athens, ¹⁸Private office, Thessaloniki, Greece, ¹⁹Private office, Kalamata, Greece, ²⁰Hygeia Hospital, Athens, Greece, ²¹Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, General Hospital of Athens “Hippokration”, Clinical Immunology-Rheumatology Unit, ²nd Department of Medicine and Laboratory, Athens, Greece, Athens, Greece

Meeting: ACR Convergence 2025

Keywords: Cohort Study, Comorbidity, Health Services Research, rheumatoid arthritis, risk factors

Session Information

Date: Tuesday, October 28, 2025

Title: (2227–2264) Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster III

Session Type: Poster Session C

Session Time: 10:30AM-12:30PM

Background/Purpose: There are limited data regarding the recent trends and risk factors for hospitalization in patients with rheumatoid arthritis (RA). Our aim was to estimate the rate, causes and predictors for hospitalizations in a real world, contemporary RA patient cohort.

Methods: Data from a multi-center, longitudinal cohort of RA patients regarding patient and disease characteristics were collected at baseline, 1 and 3 years later. The number and causes for hospitalizations by ICD-10 categories were recorded and the incidence rate was calculated. Risk factors for hospitalizations were evaluated with multivariable poisson regression analysis.

Results: 1195 RA patients were included; 78% were females with a mean age of 62 and a median disease duration of 7 years, repsectively. At baseline, 83% were on conventional synthetic DMARDs, 46% on biologic DMARDs and 39% on prednisolone (median dose: 5 mg/day). Baseline DAS28-ESR was 3.1 (median) and HAQ-DI 0.25 (median), respectively. During follow-up (3585 patient-years), 262 hospitalizations were recorded in 204 patients (17.1%) with an estimated incidence rate of 7.3/100 patient-years. The most frequent causes of hospitalization were infections (2/100 patient-years, primary of the respiratory tract), cardiovascular diseases (0.84/100 patient-years, mainly acute myocardial infarction and stroke), arthroplasties (0.78/100 patient-years) and gastrointestinal diseases (0.72/100 patient-years). By multivariable analysis, seropositivity was associated with a lower incidence (IRR=0.66, 95% CI: 0.47–0.94) while a higher disease activity status (DAS-28-ESR: 3.2-5.1 – Medium Disease Activity: IRR=1.88, 95% CI: 1.27–2.79 or High Disease Activity: IRR=2.74, 95% CI: 1.61–4.56 vs. DAS-28-ESR< 3.2: Low disease activity or remission), a higher baseline HAQ (IRR=1.64, 95% CI: 1.06–2.48), male sex (IRR=1.88, 95% CI: 1.22-2.84) and diabetes (IRR=1.99, 95% CI: 1.32–2.94, p = 0.003) were associated with a higher risk of hospitalizations, respectively.

Conclusion: In this large, longitudinal, prospective, real-life cohort of RA patients, the incidence of hospitalizations was 7.3/100 patient-years, with infections being the most common cause. Higher disease activity, impaired functional status, male sex and diabetes were independently associated with hospitalizations. These findings underscore the critical importance of tight disease control and close monitoring for infectious complications in RA patients.

Disclosures: A. Lazarini: None; K. Thomas: None; E. KALTSONOUDIS: None; P. Voulgari: None; A. Drosos: None; A. Repa: None; A. Molla ismail Sali: None; P. Sidiropoulos: None; K. Fragkiadaki: None; M. Tektonidou: None; P. Sfikakis: None; P. Tsatsani: None; S. Gazi: None; E. Argyriou: None; K. Boki: None; P. Katsimpri: None; D. Boumpas: None; G. Evangelatos: None; A. Iliopoulos: None; K. Karagianni: None; L. Sakkas: Bristol-Myers Squibb(BMS), 5; K. Melissaropoulos: None; P. Georgiou: None; E. Grika: None; P. VLACHOYIANNOPOULOS: None; T. Dimitroulas: None; A. Garyfallos: None; K. Georganas: None; P. Vounotrypidis: None; K. Ntellis: None; G. Kitas: None; D. Vassilopoulos: None.

To cite this abstract in AMA style:

Lazarini A, Thomas K, KALTSONOUDIS E, Voulgari P, Drosos A, Repa A, Molla ismail Sali A, Sidiropoulos P, Fragkiadaki K, Tektonidou M, Sfikakis P, Tsatsani P, Gazi S, Argyriou E, Boki K, Katsimpri P, Boumpas D, Evangelatos G, Iliopoulos A, Karagianni K, Sakkas L, Melissaropoulos K, Georgiou P, Grika E, VLACHOYIANNOPOULOS P, Dimitroulas T, Garyfallos A, Georganas K, Vounotrypidis P, Ntellis K, Kitas G, Vassilopoulos D. Risk factors for hospitalizations in a large, contemporary rheumatoid arthritis patient cohort [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/risk-factors-for-hospitalizations-in-a-large-contemporary-rheumatoid-arthritis-patient-cohort/. Accessed .

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