Need to aggressively target multimorbidity in RA

Multimorbidity is common in rheumatoid arthritis and progresses more rapidly during and immediately
following onset.

INTRODUCTION
Rheumatoid arthritis is a chronic inflammatory disease that can affect a person’s joints, and may cause pain and disability. Rheumatoid arthritis affects people of all ages, and is more common in women than men.

People with rheumatoid arthritis often have other chronic conditions such as osteoporosis, cardiovascular (heart) disease, cancers and mental health conditions. Traditionally, these have been considered in relation to the rheumatoid arthritis, and referred to as comorbidities. The idea of multimorbidity instead considers how having more than one chronic disease burdens the person, rather than how it affects the other disease.

WHAT DID THE AUTHORS HOPE TO FIND?
The authors wanted to see how multimorbidity affects people with rheumatoid arthritis. They also hoped to find out if there are specific timepoints during the course of rheumatoid arthritis that multimorbidity develops and changes.

WHO WAS STUDIED?
This study looked at almost 140,000 people with and without diagnoses of rheumatoid arthritis. All the people lived in the US, and had medical records in a commercial insurance database from 2006 to 2015.

About three-quarters of the people studied were female, and the average age was mid-fifties.

HOW WAS THE STUDY CONDUCTED?
This was a retrospective observational study, which means that the authors used existing databases of patient records to look back and find people for each group. Not specific treatment was studied.

The authors matched people with rheumatoid arthritis to people without, and then looked to how common
44 chronic conditions were in each of the groups. For people newly diagnosed with rheumatoid arthritis, the authors looked over the next 5 years to assess the onset and rate of progression of multimorbidity among people with and without rheumatoid arthritis.

WHAT WERE THE MAIN FINDINGS OF THE STUDY?
The main finding was that multimorbidity is twice as common in people with rheumatoid arthritis compared to those without. The rate of being diagnosed with new chronic conditions is significantly higher among people with rheumatoid arthritis, and this accelerated multimorbidity appears to start early in the disease course, perhaps even as rheumatoid arthritis is being diagnosed.

ARE THESE FINDINGS NEW?
Yes. Although it is already understood that people with rheumatoid arthritis are predisposed to other conditions, the frequency, burden, and timing of multimorbidity has not been well described before.

WHAT ARE THE LIMITATIONS OF THE STUDY?
One key limitation is that there was not much information about people’s background and lifestyle that could be taken from the database – for example, their income or level of education. These socio-demographics can have an important impact on people’s multimorbidity.

WHAT DO THE AUTHORS PLAN ON DOING WITH THIS INFORMATION?
These findings raise awareness of the burden of multimorbidity that affects people with rheumatoid arthritis. The authors encourage other researchers to target multimorbidity and improve long-term outcomes for people with rheumatoid arthritis.

WHAT DOES THIS MEAN FOR ME?
If you have rheumatoid arthritis, you might develop other health conditions. Your care team will work with you to help you make healthy lifestyle modifications, and to ensure you have appropriate disease screenings and optimal treatment for your rheumatoid arthritis and other conditions.

If you have any concerns about your disease or its treatment, you should talk to your doctor.

Disclaimer: This is a summary of a scientific article written by a medical professional (“the Original Article”). The Summary is written to assist non medically trained readers to understand general points of the Original Article. It is supplied “as is” without any warranty. You should note that the Original Article (and Summary) may not be fully relevant nor accurate as medical science is constantly changing and errors can occur. It is therefore very important that readers not rely on the content in the Summary and consult their medical professionals for all aspects of their health care and only rely on the Summary if directed to do so by their medical professional.

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Date prepared: February 2021
Summary based on research article published on: 8 October 2020
From: England BR, et al. Burden and trajectory of multimorbidity in rheumatoid arthritis: a matched cohort study from 2006 to 2015. Ann Rheum Dis 2021;80:286–292. doi:10.1136/annrheumdis-2020-218282

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