Background/Purpose: Rheumatoid arthritis (RA) related comorbidities are major determinants of morbidity and mortality. Little is known regarding the trends in these conditions. The purpose of our study was to examine whether the risk of comorbidities in RA patients has changed in recent years.

Methods: A population-based inception cohort of RA subjects who fulfilled 1987 ACR criteria for RA in 1980-2007 and a comparison cohort of subjects without RA of similar age and sex were assembled and followed until death, migration, or 7-1-2012. The presence of Charlson comorbidities (i.e., myocardial infarction, heart failure [HF], peripheral vascular disease [PVD], cerebrovascular disease, dementia, chronic obstructive pulmonary disease [COPD], ulcer, liver disease, diabetes mellitus, chronic kidney disease [CKD], and cancer) was ascertained by medical record review. Chi-square tests were used to assess trends in comorbidities present at baseline (i.e., RA incidence/index date) according to time period (1980-84 vs. 1995-2007) in each cohort. Cumulative incidence adjusted for competing risk of death was used to assess the risk of developing comorbidities during follow-up.

Results: The study included 813 RA patients and 813 non-RA subjects. Age and sex were similar in both cohorts and both time periods (mean age 56 [SD 16] years, 69% women). More patients with incident RA in the 1995-2007 time period had ≥1 Charlson comorbidity at baseline than those in the 1980-1994 time period (56% vs 44%; p<0.001). However, this trend was similar in the non-RA cohort (50% vs. 38%; p<0.001). Comorbidities that increased over time included cancer, CKD, COPD and liver disease in both cohorts, PVD and cerebrovascular disease in RA and HF in non-RA. However, among those with no comorbidities at baseline, the cumulative incidence of ≥1 Charlson comorbidity by 10 years later was lower among those with incident RA in the 1995-2007 time period than the 1980-1994 time period (22% vs. 27%; p=0.008), with similar findings for non-RA (17% vs. 25%; p=0.03). Considering both prevalent and incident comorbidities, there was no significant change over time in the cumulative incidence of ≥1 comorbidity at 10 years in the RA (76% in 1995-2007 vs. 71% in 1980-1994; p=0.11) or non-RA cohorts (67% in 1995-2007 vs. 64% in 1980-1994; p=0.07).

Conclusion: Although the prevalence of comorbidities at baseline was higher in more recent years in both the RA and non-RA cohorts, the rate of occurrence of new comorbidities has declined over time.  This may indicate earlier recognition and improved management of comorbidities both in the RA and in the general population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/time-trends-in-comorbidities-among-patients-with-rheumatoid-arthritis-compared-to-the-general-population/