Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA)

Abstract

Background: PATIENTS with rheumatoid arthritis (RA) are at increased risk of developing comorbid conditions.

Objectives: To evaluate the prevalence of comorbidities and compare their management in RA patients from different countries worldwide.

Study design: international, cross-sectional.

Patients: consecutive RA patients.

Data collected: demographics, disease characteristics (activity, severity, treatment), comorbidities (cardiovascular, infections, cancer, gastrointestinal, pulmonary, osteoporosis and psychiatric disorders).

Results: Of 4586 patients recruited in 17 participating countries, 3920 were analysed (age, 56±13 years; disease duration, 10±9 years (mean±SD); female gender, 82%; DAS28 (Disease Activity Score using 28 joints)-erythrocyte sedimentation rate, 3.7±1.6 (mean±SD); Health Assessment Questionnaire, 1.0±0.7 (mean±SD); past or current methotrexate use, 89%; past or current use of biological agents, 39%. The most frequently associated diseases (past or current) were: depression, 15%; asthma, 6.6%; cardiovascular events (myocardial infarction, stroke), 6%; solid malignancies (excluding basal cell carcinoma), 4.5%; chronic obstructive pulmonary disease, 3.5%. High intercountry variability was observed for both the prevalence of comorbidities and the proportion of subjects complying with recommendations for preventing and managing comorbidities. The systematic evaluation of comorbidities in this study detected abnormalities in vital signs, such as elevated blood pressure in 11.2%, and identified conditions that manifest as laboratory test abnormalities, such as hyperglycaemia in 3.3% and hyperlipidaemia in 8.3%.

Conclusions: Among RA patients, there is a high prevalence of comorbidities and their risk factors. In this multinational sample, variability among countries was wide, not only in prevalence but also in compliance with recommendations for preventing and managing these comorbidities. Systematic measurement of vital signs and laboratory testing detects otherwise unrecognised comorbid conditions.

Keywords: Cardiovascular Disease; Epidemiology; Lipids; Rheumatoid Arthritis; Vaccination.

Figure 1

Prevalence of evaluated comorbidities in the 3920 patients with rheumatoid arthritis. COPD, chronic obstructive pulmonary disease.

Figure 2

Prevalence of risk factors for cardiovascular and cancer diseases in the 3920 patients with rheumatoid arthritis. IBD, inflammatory bowel disease.

Figure 3

Percentage of patients optimally monitored with respect to some comorbidities. Vit.D suppl., vitamin D supplementation.