Abstract
To compare comorbidities in a cohort of cyclic citrullinated peptide (CCP) antibody positive patients without or prior to onset of inflammatory arthritis (IA) to those in patients with early IA. Baseline data from two established cohorts were used. The first recruited people at risk of IA: CCP antibody positive cases without IA (CCP Cohort, n = 296). The second cohort [the Inflammatory Arthritis CONtinuum study (IACON)] recruited patients with early IA (n = 725). Proportions of patients with given comorbidities were compared between cohorts and then logistic regression was used to determine odds ratios (OR) for the CCP cohort having specific comorbidities, compared to IACON patients. Analyses adjusted for gender, age, smoking status, and body mass index. Patients from the CCP cohort were younger (mean age 50, compared to 53 years). The proportion of patients with at least one comorbidity was higher in the IACON than the CCP cohort: (40% compared to 24%, respectively). Results of logistic regression analyses suggested the odds of hypertension, taking a lipid-lowering agent, ischemic heart disease, cerebrovascular disease, lung disease, and diabetes were not increased in either cohort. However, patients in the CCP cohort were more likely to be taking an antidepressant (OR = 1.62, 95% CI 1.03, 2.56, p = 0.037). There was no significant difference in comorbidities among people with CCP antibodies but without IA, compared to those of patients with established IA.
Highlights
The presence of comorbidities in inflammatory arthritis (IA) has been linked with worse disease outcomes, including lower achievement of disease-remission [1] and premature death in the case of rheumatoid arthritis (RA), the commonest subset of IA [2, 3]
We found that the prevalence of comorbidities in IACON were similar to those reported from a similar UK cohort of patients with early IA, the Norfolk Arthritis Register [13]
The initial comparison of the two cohorts implied that specific comorbidities affected greater proportions of patients in IACON than the cyclic citrullinated peptide (CCP) cohort, but further analysis indicated that confounders, such as age, gender, smoking, and body mass index (BMI), might explain this difference
Summary
The presence of comorbidities in inflammatory arthritis (IA) has been linked with worse disease outcomes, including lower achievement of disease-remission [1] and premature death in the case of rheumatoid arthritis (RA), the commonest subset of IA [2, 3]. Comorbidities in At-Risk CCP Positive Individuals having been reported at the outset of disease, increasing with follow-up [4]. UK data support a changing population demography over time with a rising prevalence of risk factors such as obesity [5], and multimorbidity in general [6]. Recent data have shown increasing age and level of comorbidity at disease presentation in two large RA inception cohorts spanning a 25-year period [7]. The mechanisms underlying these secular trends are not easy to delineate and could be related to several factors, including changing population demographic trends, changing disease phenotype, and treatment use. It is acknowledged that earlier detection and screening for comorbidities may explain these trends
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