Multimorbidity increases mortality, MACE risk in patients with rheumatoid arthritis

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).

• 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.

• 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).

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