Cardiovascular Comorbidities Relate More than Others with Disease Activity in Rheumatoid Arthritis

Gloria Crepaldi; Carlo Alberto Scirè; Greta Carrara; Garifallia Sakellariou; Roberto Caporali; Ihsane Hmamouchi; Maxime Dougados; Carlomaurizio Montecucco

doi:10.1371/journal.pone.0146991

Cardiovascular Comorbidities Relate More than Others with Disease Activity in Rheumatoid Arthritis

PLoS One. 2016 Jan 12;11(1):e0146991. doi: 10.1371/journal.pone.0146991. eCollection 2016.

Authors

Gloria Crepaldi¹, Carlo Alberto Scirè², Greta Carrara², Garifallia Sakellariou¹, Roberto Caporali¹, Ihsane Hmamouchi³, Maxime Dougados⁴, Carlomaurizio Montecucco¹

Affiliations

¹ Department of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
² Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy.
³ Mohammed V Souissi University, Faculty of Medicine, Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Rabat, Morocco.
⁴ Rheumatology B Department, Hospital Cochin, Medicine Faculty, Paris-Descartes University, Paris, France.

Abstract

Objectives: To explore the influence of comorbidities on clinical outcomes and disease activity in rheumatoid arthritis (RA).

Methods: In patients included in the cross-sectional observational multicenter international study COMORA, demographics, disease characteristics and comorbidities (hypertension, diabetes, hyperlipidemia, renal failure, ischemic heart disease, stroke, cancer, gastro-intestinal ulcers, hepatitis, depression, chronic pulmonary disease, obesity) were collected. Multivariable linear regression models explored the relationship between each comorbidity and disease activity measures: 28-swollen joint count (SJC), 28-tender joint count (TJC), erythrocyte sedimentation rate (ESR), patient's and physician's global assessment (PtGA, PhGA), patient reported fatigue and 28-Disease Activity Score (DAS28). Results are expressed as mean difference (MD) adjusted for the main confounders (age, gender, disease characteristics and treatment).

Results: A total of 3,920 patients were included: age (mean ±SD) 56.27 ±13.03 yrs, female 81.65%, disease duration median 7.08 yrs (IQR 2.97-13.27), DAS28 (mean ±SD) 3.74 ± 1.55. Patients with diabetes had more swollen and tender joints and worse PtGA and PhGA (MD +1.06, +0.93, +0.53 and +0.54, respectively). Patients with hyperlipidemia had a lower number of swollen and tender joints, lower ESR and better PtGA and PhGA (MD -0.77, -0.56, -3.56, -0.31 and -0.35, respectively). Patients with history of ischemic heart disease and obese patients had more tender joints (MD +1.27 and +1.07) and higher ESR levels (MD +5.64 and +5.20). DAS28 is influenced exclusively by cardiovascular comorbidities, in particular diabetes, hyperlipidemia, ischemic heart disease and obesity.

Conclusions: Cardiovascular comorbidities relate more than others with disease activity in RA. Diabetes and hyperlipidemia in particular seem associated with higher and lower disease activity respectively influencing almost all considered outcomes, suggesting a special importance of this pattern of comorbidities in disease activity assessment and clinical management.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Arthritis, Rheumatoid / complications*
Cardiovascular Diseases / complications*
Comorbidity
Cross-Sectional Studies
Fatigue
Female
Humans
International Cooperation
Joints / pathology
Male
Middle Aged
Severity of Illness Index
Treatment Outcome

Grants and funding

The COMORA study was conducted with the support of an unrestricted grant from Roche Ltd. The ancillary analysis described in this manuscript has been done without any type of funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.