Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Patients with rheumatoid arthritis (RA) suffer from both physical disabilities and medical comorbidities and tend to use emergency room for many reasons. However, the detail has not been well investigated from the perspective of emergency medicine. The aim of this study is to identify the risks to visit emergency room in RA patients.
Methods:
We retrospectively reviewed all emergency room visits in RA patients followed at Tokyo Metropolitan Tama Medical Center from April 2007 to March 2009 using an electric health record system. We compared the characteristics of RA patients who visited emergency room (“ER user group”) to those who did not visit emergency room (“Control”). We compared the background characteristics between the two groups. A logistic regression analysis was performed to evaluate the risks of emergency room visits.
Results:
“ER user group” and “Control” included 294 and 298 patients. The background characteristics of both groups were summarized in Table 1. By a logistic regression analysis, cardiovascular diseases, prednisolone>5mg/d, anti-TNF agents, age over 65, and pulmonary diseases predicted emergency room visits with odds ratio of 4.2, 3.5, 3.3, 1.7, and 1.6 respectively (Table2).
Conclusion:
Preexisting cardiovascular disease, prednisolone>5mg/d, and anti-TNF agents were considered higher risks for emergency room visits in patients with RA.
Table 1
Background characteristics of “ER user” and “Control”
|
|
ER user (294 pts) N (%) |
Control (298 pts) N (%) |
p |
|
Age, year±SD
|
68.0±11.1 |
63.1±12.3 |
<0.001 |
|
Disease duration, year±SD
|
15.3±12.6 |
12.8±11.7 |
0.017
|
|
Female |
235 (80%) |
241 (81%) |
NS |
|
Diabetes mellitus |
49 (17%) |
27 (9%) |
0.005
|
|
Pulmonary diseases*1 |
82 (28%) |
49 (16%) |
0.001
|
|
Cardiovascular diseases*2 |
40 (14%) |
8 (3%) |
<0.001 |
|
Glucocorticoids |
214 (73%) |
149(50%) |
<0.001 |
|
Prednisolone equivalent (mg/day) |
4.2±4.0 |
2.2±2.6 |
<0.001 |
|
Methotrexate |
146 (50%) |
143 (48%) |
NS |
|
Anti-TNF agents |
28 (10%) |
12 (4%) |
0.007 |
|
Salazosulfapyridine |
54 (18%) |
55 (18%) |
NS |
|
Bucillamine |
43 (15%) |
32 (11%) |
NS |
*1 Pulmonar diseases: interstitial lung disease, old tuberculosis, asthma, bronchiectasis, nontuberculous mycobacteriosis, chronic obstructive pulmonary disease
*2 Cardiovascular diseases: heart failure, old myocardial infarction, angina pectoris
NS: not statistically significant
Table 2
Multivariate logistic analysis to predict emergency room visits
|
Variable |
Odds ratio |
P |
|
Cardiovascular disease |
4.2 |
<0.001 |
|
Prednisolone equivalent >5mg/d |
3.5 |
<0.001 |
|
Anti-TNF agents |
3.3 |
0.001 |
|
Age over 65 |
1.7 |
0.003 |
|
Diabetes mellitus |
1.7 |
NS (0.051) |
|
Pulmonary disease |
1.6 |
0.030 |
*1 Pulmonar diseases: interstitial lung disease, old tuberculosis, asthma, bronchiectasis, nontuberculous mycobacteriosis, chronic obstructive pulmonary disease
*2 Cardiovascular diseases: heart failure, old myocardial infarction, angina pectoris
NS: not statistically significant
Disclosure:
Y. Nagai,
None;
N. Yokogawa,
None;
K. Shimada,
None;
S. Sugii,
None.
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