POS0620 RHEUMATIC DISEASE COMORBIDITY INDEX: IT IS A PREDICTOR OF OUTCOMES IN RHEUMATOID ARTHRITIS?

Abstract

BackgroundComorbidities are frequent among patients with rheumatoid arthritis (RA). They influence clinical outcomes and treatment response. Comorbidity indices are developed to study their impact on different outcomes [1].ObjectivesThe aim of our study was to assess comorbidity among RA patients and to explore the association between comorbidities and the clinical profile of the rheumatic disease.MethodsWe conducted a retrospective study in our rheumatology department including 255 patients with established RA according to the ACR/EULAR 2010 criteria. The Disease Activity Scale (DAS28) and the functional impairment (HAQ) were noted. Comorbidities were collected. Rheumatic Disease Comorbidity Index (RDCI) was calculated for each patient. It is rated from 0 to 9 and comprises 11 comorbid conditions including lung disease, cardio-vascular disease, hypertension, diabetes, fracture, depression, cancer, and gastrointestinal ulcer [2].ResultsThere were 255 RA with sex ratio M/F at 0.2. The mean age was 58.92 ± 10.72 years [25-85]. The mean age at onset of disease was 43.78 ± 14.28 years [13-81]. The mean disease duration was 16.32 ± 14.3 [1-72]. Identified comorbidities were: hypertension (31.4%), lung disease (27.1%), diabetes (19.6%), cardio-vascular disease (16.8%), gastrointestinal ulcer (9.2%), depression (8.8%), and chronic renal failure (8%).The mean RDCI was 1.14 ± 1.25 [0-6]. A statistically significant correlation was found between RDCI and age (p<10-3, r=0.277), RDCI and age at disease onset (p<10-3, r=0.3). RDCI was not correlated to the disease duration (p=0.27). RDCI was not associated with the DAS28 (p=0.5) nor with the HAQ (p=0.4). RCDI was not significantly different in terms of sex (female: 1.2 vs male: 1.3, p=0.09). This comorbidity index was associated with the presence of extra articular manifestation (presence: 1.4 vs absence: 0.8, p=0.004). It was associated with pulmonary involvement (presence: 1.7 vs absence: 0.6, p<10-3). There was an association between the presence of radiographic erosions and RDCI (1.2 vs 1, p=0.001). RDCI was also associated with atlanto-axial dislocation (p=0.009) and with coxitis (p=0.009). Comorbidity index was statistically different between patients on biologic drugs and patients without biologic drugs (1.6 vs 0.9, p<10-3).ConclusionOur study showed that comorbidity index was associated with a severe disease and signs of poor prognosis (erosions, coxitis, andatlanto-axial dislocation). This confirmed the hypothesis that comorbidity can be a threat to the improvement in the long-term prognosis in RA patients.