Multimorbidity increases mortality, MACE risk in patients with rheumatoid arthritis

  • McQueenie R & al.
  • BMJ Open
  • 23 Nov 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Multiple long-term conditions (LTCs) were common in patients with rheumatoid arthritis (RA).
  • Patients with RA and other LTCs, particularly comorbid osteoporosis, were at an increased risk of all-cause mortality and major adverse cardiovascular events (MACE).

Why this matters

  • Future clinical guidelines for RA should acknowledge the importance of multimorbidity when considering management planning and patient outcomes.

Study design

  • This population-based study used data from the UK Biobank to evaluate the effect of multimorbidity and a wide range of comorbid LTCs (n=42) on all-cause mortality and MACE in patients with RA (n=5658).
  • Funding: Versus Arthritis.

Key results

  • Overall, 75.7% of patients with RA had multimorbidity (34.5% of participants had 2-3 LTCs and 11.1% had ≥4 LTCs).
  • The risk of all-cause mortality was increased in patients with RA and other LTCs:
    • RA and 2-3 LTCs (aHR, 2.48; 95% CI, 2.12-2.90); and
    • RA and ≥4 LTCs (aHR, 3.30; 95% CI, 2.61-4.16).
  • Similarly, the risk of MACE was increased with:
    • RA and 2-3 LTCs (aHR, 2.09; 95% CI, 1.73-2.54); and
    • RA and ≥4 LTCs (aHR, 3.39; 95% CI, 2.61-4.40).
  • Of the comorbid LTCs studied, osteoporosis was most strongly associated with adverse outcomes in patients with RA:
    • all-cause mortality (aHR, 2.20; 95% CI, 1.55-3.12); and
    • MACE (aHR, 3.17; 95% CI, 2.17-4.64).

Limitations

  • Data on RA and LTCs were self-reported.
  • Lack of information on RA disease severity.