Comorbidities In Rheumatoid Arthritis Research Articles

Influence of dietary habits on depression among patients with rheumatoid arthritis: A cross-sectional study using KURAMA cohort database.

ObjectiveAlthough mental disorder is one of the most common comorbidities of rheumatoid arthritis (RA) and is known as a critical influence on RA remission rates, there is little knowledge regarding a possible therapeutic strategy for depression or anxiety in a RA population. Most recently, clinical evidence of dietary improvement for depression has emerged in a general population, but the relationship between dietary habits and mental disorder has not been investigated in RA. The purpose of this study is to elucidate clinical associations between mental disorder (depression/anxiety), dietary habits and disease activity/physical function in patients with RA.MethodsA cross-sectional study was performed with 267 female outpatients from the KURAMA database. Using the Hospital Anxiety and Depression Scale (HADS), we classified the participants into three groups by depression state, and their characteristics were compared. Using the 20-items on the self-reported food frequency questionnaire, we investigated the relationship between dietary habits and depression or anxiety, adopting a trend test and a multivariate standardized linear regression analysis for the HADS score of depression or that of anxiety as a dependent variable.ResultsAccording to the classified stage of depression, current disease activity (DAS28-CRP: 28-Joint RA Disease Activity Score-C-reactive protein) and the health assessment questionnaire disability Index (HAQ-DI) were significantly increased. Trend analyses revealed that the depression score was inversely associated with the consumption of three food (fish, vegetables and fruit) out of twenty as was the anxiety score with only fish intake. Furthermore, multiple linear regression analysis revealed that the depression score was negatively associated with frequent fish intake (≥ 3 times per week) (Estimate -0.53, p = 0.033), HAQ-DI score within normal range (Estimate -0.88, p ≤ 0.001) and MTX use (Estimate -0.60, p ≤ 0.023). For the anxiety score, multivariate analysis showed similar but not significant associations with variables except for HAQ-DI score.ConclusionsIn a RA population, both depression and anxiety had a significant and negative association with HAQ-DI score, and depression rather than anxiety had negative association with frequent fish intake. Modification of dietary habits such as increased fish consumption may have a beneficial effect on the depression state in RA patients.

Prevalence of Sarcopenia and its Association with Antirheumatic Drugs in Middle-Aged and Older Adults with Rheumatoid Arthritis: A Systematic Review and Meta-analysis

To examine the prevalence of sarcopenia and its association with antirheumatic drugs in adults with rheumatoid arthritis (RA). This review was registered on PROSPERO and followed PRISMA guidelines. Electronic databases were searched for studies reporting on the prevalence of sarcopenia in adults with RA using any muscle index (muscle mass, strength and/or physical performance) and cutpoints as recommended by established criteria (EWGSOP1/2, AWGS, FNIH, SDOC). The secondary objective was to investigate the relationship between RA, antirheumatic drugs, and sarcopenia. Among 2240 middle-aged and older adults with RA (mean age: 47.7 ± 5.5 to 75.0 ± 6.2years, 83.8% women), the pooled prevalence of low muscle mass/sarcopenia was 30.2% [95% confidence interval (CI) 24.2-36.2%; 16 studies; I2: 89.2%]. Sub-group analysis showed a non-significant higher prevalence of low muscle mass alone (32.6%, 95% CI 25.0-40.3%; I2: 87.9%) versus consensus definitions of sarcopenia (25.4%, 95% CI 15.4-35.3%; I2: 91.2%, p = 0.255). In adults with RA, corticosteroid use was positively associated with sarcopenia [odds ratio (OR) 1.46, 95% CI 0.94-2.29, 7 studies; I2: 47.5%] while conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was inversely associated (OR 0.70, 95% CI 0.52-0.94; 6 studies: I2: 0.00%) with this muscle disease. No association was found for biological/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) (OR 0.83, 95% CI 0.54-1.30; 6 studies: I2: 47.6%). Sarcopenia is a common comorbidity of RA, and as such, clinicians should screen for this muscle disease in adults with RA. Further longitudinal studies are needed to understand the role of antirheumatic drugs (particularly type, dosing, and duration) in the development of sarcopenia.

Health care costs of rheumatoid arthritis: A longitudinal population study.

Quantifying the contribution of rheumatoid arthritis to the acquisition of subsequent health care costs is an emerging focus of the rheumatologic community and payers of health care. Our objective was to determine the healthcare costs before and after diagnosis of rheumatoid arthritis (RA) from the public payer’s perspective. The study design was a longitudinal observational administrative data-based cohort with RA cases from Ontario Canada (n = 104,933) and two control groups, matched 1:1 on year of cohort entry from 2001 to 2016. The first control group was matched on age, sex and calendar year of cohort entry (diagnosis year for those with RA); the second group added medical history to the match before RA diagnosis year. The main exposure was new onset RA. The secondary exposure was calendar year of RA diagnosis to compare attributable costs over the study observation window. Main outcomes were health care costs in 2015 Canadian dollars, overall and by cost category. We used attribution methods to classify costs into those associated with RA, those associated with comorbidities, and age/sex-related underlying costs. Health care costs associated with RA increased up to the year of diagnosis, where they reached $8,591: $4,142 in RA associated costs; $1,242 in RA comorbidity associated costs; and $3,207 in underlying costs. In the eighth-year post diagnosis, the RA costs declined to $2,567 while the RA comorbidity associated costs remained relatively constant at $1,142, and the underlying age/sex related cost increased to $4,426. RA patients had lower costs when diagnosed in later calendar years. Our results suggest a large proportion of disease related health care costs are a result of costs associated with RA comorbidities, which may appear many years before diagnosis.

O27 Frailty and co-morbidity in people with osteoarthritis and rheumatoid arthritis

Abstract Background/Aims People with osteoarthritis (OA) and rheumatoid arthritis (RA) are at increased risk of frailty, though the role of co-morbidities in contributing to frailty risk in these arthritides is uncertain. The aim of this study was i) to determine the association between common co-morbidities and frailty in OA and RA; and ii) to determine whether co-morbidities interact synergistically with OA and RA to increase the likelihood of frailty. Methods A cross-sectional analysis of the UK Biobank data was carried out. In this national cohort of participants aged 40-69 years, self-reported physician-diagnosed diseases including OA, RA, and common co-morbidities (including hypertension, coronary heart disease, diabetes, stroke/TIA, chronic obstructive pulmonary disease (COPD), and depression) were recorded. Frailty was assessed using a modification of the frailty phenotype (FP), comprising five components: self-reported weight loss, exhaustion, low physical activity (international activity questionnaire), slow walking speed, and low hand-grip strength. Pre-frailty and frailty, was identified based on the presence of 1-2 and ≥3 of these components, respectively. Among participants with OA and RA at baseline, the likelihood of being pre-frail or frail (vs not frail) at baseline among people with (vs without) each of the co-morbidities was assessed using multinomial logistic regression. To determine whether co-morbidities interact synergistically with OA and RA to increase the likelihood of frailty, deviation from additivity of risk was estimated by calculating the attributable proportion (AP) of risk due to biological interaction. An AP > 0 indicates positive (synergistic) biological interaction. Analyses were adjusted for age, sex, smoking status, BMI, and deprivation. Results In total, 457,561 people were included in the analysis; 35,884 (7.8%) had OA and 4,894 (1.1%) had RA. Overall, the mean (SD) age was 56.5 (8.1) years and 54% were female. The overall prevalence of frailty was 3.4%. The prevalence of frailty was higher among those with OA (10.0%) and RA (18.6%). Each of the co-morbidities considered was associated with increased relative risk of pre-frailty and frailty particularly COPD in OA, relative risk ratio (95%CI): pre-frailty, 2.09 (1.80, 2.42) and frailty, 4.45 (3.71, 5.33) and stroke/TIA in RA: pre-frailty, 1.97 (1.18, 3.29) and frailty, 3.64 (2.11, 6.29). Most of the co-morbidities considered interacted synergistically with OA and RA to increase the risk of pre-frailty and frailty, particularly diabetes in OA, AP (95% CI): pre-frailty, 0.13 (0.04, 0.23) and frailty, 0.49 (0.42, 0.55) and stroke/TIA in RA: pre-frailty, 0.34 (0.003, 0.68) and frailty 0.60 (0.38, 0.82). Conclusion Co-morbidity is associated with an increased occurrence of pre-frailty and frailty among people with OA and RA and interacts synergistically with OA and RA to increase the likelihood of pre-frailty and frailty. Disclosure M.J. Cook: None. M. Lunt: None. S.M.M. Verstappen: None. T.W. O'Neill: None.

Cardiac Dysfunction in Rheumatoid Arthritis: The Role of Inflammation.

Rheumatoid arthritis is a chronic, systemic inflammatory disease that carries an increased risk of mortality due to cardiovascular disease. The link between inflammation and atherosclerotic disease is clear; however, recent evidence suggests that inflammation may also play a role in the development of nonischemic heart disease in rheumatoid arthritis (RA) patients. We consider here the link between inflammation and cardiovascular disease in the RA community with a focus on heart failure with preserved ejection fraction. The effect of current anti-inflammatory therapeutics, used to treat RA patients, on cardiovascular disease are discussed as well as whether targeting resolution of inflammation might offer an alternative strategy for tempering inflammation and subsequent inflammation-driven comorbidities in RA.

Development and feasibility of 4 checklists for the evaluation of comorbidity in patients with rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis: GECOAI Project

ObjectiveTo develop and assess the feasibility in daily practice of four comorbidity checklists, for common use in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). MethodsA multidisciplinary panel of experts on comorbidity was established. Data from the GECOAR, GECOAX and GECOAP projects were analysed and a narrative literature review in Medline on RA, axSpA and PsA comorbidity was performed in order to select the most relevant and common comorbidities across the three diseases. With these results and those obtained from a focus group of patients, in a nominal group meeting, the experts generated preliminary checklists. These were afterwards modified by an external evaluation by two associations, a patients’ association and an association of health professionals related to rheumatology. As a result, the final checklists were generated. A cross-sectional study was conducted to test the feasibility of three of the checklists in daily practice, in which eight health professionals evaluated the checklists in five patients with RA, five with axSpA and five with SpA. ResultsFour comorbidity checklists were designed, three for health professionals (one to assess current comorbidity, one on prevention/health promotion and one with the referral criteria to other health professionals), and another for patients. The feasibility study showed them to be simple, clear, and useful for use in routine clinical practice. ConclusionsThe use of specific and common checklists for patients with RA, axSpA and PsA is feasible and might contribute favorably to their prognosis as well as in daily practice.

Local adaptation of recommendation-based materials for shared decision-making and management of comorbidity in rheumatoid arthritis.

To describe local adaptations of materials derived from evidence-based recommendations in a training programme in rheumatoid arthritis (RA). The eRA (evolving the management of rheumatoid arthritis) programme generated shared decision-making practises and a checklist for managing comorbidity in RA, among others, at the international level. Unmet needs in RA management were first identified and prioritised. Then educational materials were designed and developed to address these gaps. These materials were evaluated in detailed and discussed in small regional groups by practicing rheumatologists. Voting, open discussions and recommendations were extracted from the meetings. Thirty-five Spanish rheumatologists discussed a comorbidity checklist and a shared decision-making tool. The results of the local meetings were synthesised as (1) a judicious commitment to check agreed comorbidities, and (2) a list of barriers and facilitators for the implementation of shared decision making in the local settings. With regards to ways to implement the agreed list and periodicity, two issues stand-out: (1) patient education and (2) the need of easy access to information and the use of local organisational systems in place. With respect to shared decision-making, issues raised included messages for self-awareness, challenges, and practical facilitators. Discussion, adaptation, and planning are needed before implementing any evidence-based recommendation and materials if we want to achieve a successful implementation. Further studies should demonstrate whether this initiative was successful in achieving the goals of improved patient care. Our experience could be used as a guidance or example for implementation elsewhere.

CCR2/CCL2 and CMKLR1/RvE1 chemokines system levels are associated with insulin resistance in rheumatoid arthritis.

Rheumatoid arthritis (RA) has been associated with insulin resistance (IR). Due to an excess in storage of white adipose tissue, IR has an inflammatory process that overlaps with RA. This is performed by the activation/migration of monocytes carried out by the CCR2/CCL2 and CMKLR1/RvE1 chemokines systems. Furthermore, these can potentiate chronic inflammation which is the central axis in the immunopathogenesis of RA. We evaluated the association between the relative expression of CCR2 and CMKLR1 and the serum levels of their ligands CCL2 and RvE1, in the context of adiposity status with IR as a comorbidity in RA. We studied 138 controls and 138 RA-patients classified with and without IR. We evaluated adiposity, RA activity, IR status and immunometabolic profiles by routine methods. Insulin, CCL2 and RvE1 serum levels were determined by ELISA. Relative expression of CCR2, CMKLR1 and RPS28 as constitutive gene by SYBR green RT-qPCR and 2-ΔΔCT method. Increased measurements were observed of body adiposity and metabolic status as follows: RA with IR>control group with IR>RA without IR> control group without IR. CCR2 and CMKLR1 relative expression was increased in RA without IR versus control without IR. CCR2: 2.3- and 1.3-fold increase and CMKLR1: 3.5- and 2.7-fold increase, respectively. Whereas, CCR2 expression correlates with CMKLR1 expression (rho = 0.331) and IR status (rho = 0.497 to 0.548). CMKLR1 expression correlates with inflammation markers (rho = 0.224 to 0.418). CCL2 levels were increased in the RA groups but levels of RvE1 were increased in RA without IR. We conclude that in RA with IR, the chemokine receptors expression pattern showed a parallel increase with their respective ligands. RA and IR in conjunction with the pathological distribution of body fat mass might exacerbate chronic inflammation. These results suggest that high CCL2 levels and compensatory RvE1 levels might not be enough to resolve the inflammation by themselves.

Mini-Review: The Contribution of Adipokines to Joint Inflammation in Inflammatory Rheumatic Diseases.

Inflammatory rheumatic diseases (IRD) are complex disorders characterized by chronic inflammation of the joints and related skeletal structures. The most common forms of IRD are rheumatoid arthritis (RA) and spondyloarthritis (SpA), including axial SpA (axSpA) and psoriatic arthritis (PsA). Obesity is a frequent comorbidity in RA and PsA, and to a lesser extend in axial SpA. The association between obesity and IRD may be explained by the release from fat tissue of several bioactive proteins, namely adipokines. Adipokines are involved in the regulation of various processes such as lipid or glucose metabolism, but also inflammation. Adipokines are interrelated with the immune system, with both innate and adaptive immune cell connections. Several adipokines with pro-inflammatory effects have been identified such as leptin, visfatin or resistin. Conversely, adiponectin and more specifically its low molecular weight isoform, is considered to have antiinflammatory properties. In this review, we discuss the contribution of adipokines to the joint inflammation of IRD, the relation they have with immune pathways of these diseases, their links with the structural impact on peripheral joints and/or axial skeleton, and also the influence they may have on the cardiometabolic risk of IRD.

The Link Between Autonomic Nervous System and Rheumatoid Arthritis: From Bench to Bedside.

Neuronal stimulation is an emerging field of research focused on the management and treatment of various diseases through the reestablishment of physiological homeostasis. Electrical vagus nerve stimulation has recently been proposed as a revolutionary therapeutic option for rheumatoid arthritis (RA) in combination with or even as a replacement for conventional and biological drugs. In the past few years, disruption of the autonomic system has been linked to RA onset and activity. Novel research on the link between the autonomic nervous system and the immune system (immune-autonomics) has paved the way for the development of innovative RA management strategies. Clinical evidence supports this approach. Cardiovascular involvement, in terms of reduced baroreflex sensitivity and heart rate variability-derived indices, and mood disorders, common comorbidities in patients with RA, have been linked to autonomic nervous system dysfunction, which in turn is influenced by increased levels of circulating pro-inflammatory cytokines. This narrative review provides an overview of the autonomic nervous system and RA connection, discussing most of the common cardiac and mental health-related RA comorbidities and their potential relationships to systemic and joint inflammation.

Osteoporosis in Rheumatoid Arthritis: Dangerous Liaisons.

Osteoporosis has been classically considered a comorbidity of rheumatoid arthritis (RA). However, recent advances in the pathogenesis of osteoporosis in RA have shown a close interplay between cells of the immune system and those involved in bone remodeling, introducing new actors into the classic route in which osteoclast activation is related to the RANK/RANKL/OPG pathway. In fact, the inflammatory state in early stages of RA, mediated by interleukin (IL)-1, IL-6, IL-8 and tumor necrosis factor (TNF)-α has the ability to activate and differentiate osteoclasts not only through their relationship with RANKL, but also through the Wnt/DKK1/sclerostin pathway, leading to bone loss. The role of synovial fibroblasts and activated T lymphocytes in the expression of the RANKL system and its connection to bone destruction is also depicted. In addition, autoantibodies such as rheumatoid factor and anti-citrullinated protein antibodies are other pathogenic mechanisms for the development of bone erosions and systemic osteoporosis in RA, even before the onset of arthritis. The aim of this review is to unravel the relationship between different factors involved in the development of osteoporosis in RA patients, both the classic factors and the most novel, based on the relationship of autoantibodies with bone remodeling. Furthermore, we propose that bone mineral density measured by different techniques may be helpful as a biomarker of severity in early arthritis patients.

Development of a Patient-centered Quality Measurement Framework for Measuring, Monitoring, and Optimizing Rheumatoid Arthritis Care in Canada.

The aim of this study was to develop a patient-centered quality measurement framework to address a predefined vision statement and 7 strategic objectives for rheumatoid arthritis (RA) care that was developed in prior qualitative work with arthritis stakeholders. One hundred forty-seven RA-related performance measures (PMs) were identified from a systematic review. A candidate list of 26 PMs meeting predefined criteria and addressing the strategic objectives previously defined was then assessed during a 3-round (R) modified Delphi. Seventeen panelists with expertise in RA, quality measurement, and/or lived experience with RA rated each PM on a 1-9 scale based on the items of importance, feasibility, and priority for inclusion in the framework during R1 and R3, with a moderated discussion in R2. PMs with median scores ≥ 7 on all 3 items without disagreement were included in the final set, which then underwent public comment. Twenty-one measures were included in the final framework (15 PMs from the Delphi and 6 published system-level measures on access to care and treatment). The measures included 4 addressing early access to care and timely diagnosis, 12 evidence-based care for RA and related comorbidities, 1 addressing patient participation as an informed partner in care, and 4 on patient outcomes. The proposed framework builds upon existing measures capturing early access to care and treatment in RA and adds important PMs to promote high-quality RA care and outcome measurement. In the next phase, the authors will test the framework in clinical practice in addition to addressing certain areas where no suitable PMs were identified.

Understanding the Role of Interleukin-6 (IL-6) in the Joint and Beyond: A Comprehensive Review of IL-6 Inhibition for the Management of Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a chronic, debilitating autoimmune disorder involving inflammation and progressive destruction of the joints, affecting up to 1% of the population. The majority of patients with RA have one or more comorbid conditions, the most common being cardiovascular disease, osteoporosis, and depression, the presence of which are associated with poorer clinical outcomes and lower health-related quality of life. RA pathogenesis is driven by a complex network of proinflammatory cells and cytokines, and of these, interleukin-6 (IL-6) plays a key role in the chronic inflammation associated with RA. Through cell signaling that can be initiated by both membrane-bound and soluble forms of its receptor, IL-6 acts both locally to promote joint inflammation and destruction, and in the circulation to mediate extra-articular manifestations of RA, including pain, fatigue, morning stiffness, anemia, and weight loss. This narrative review describes the role of IL-6 in the pathogenesis of RA, its comorbidities, and extra-articular systemic manifestations, and examines the effects of the IL-6 receptor inhibitors sarilumab and tocilizumab on clinical endpoints of RA, patient-reported outcomes, and common comorbidities and extra-articular manifestations.

Coexistent Hyperuricemia and Gout in Rheumatoid Arthritis: Associations With Comorbidities, Disease Activity, and Mortality.

Although hyperuricemia and gout can complicate the course of rheumatoid arthritis (RA), the impact of these factors on outcomes in RA is unclear. We undertook this study to examine associations of coexistent hyperuricemia and gout with RA disease measures, RA treatments, and survival. Participants from a longitudinal RA study were categorized by the presence of gout and serum urate (UA) status. Groups were compared by baseline patient characteristics, RA disease activity, treatments, and comorbidities. Associations of baseline serum UA levels with all-cause and cardiovascular disease (CVD)-related mortality were examined in multivariable survival analyses. Of 1,999 participants with RA, 341 (17%) had serum UA concentrations of >6.8 mg/dl, and 121 (6.1%) were diagnosed with gout. There were no significant associations of serum UA concentration or gout with RA disease activity or treatment at enrollment, with the exception that those with gout were more likely to be receiving sulfasalazine and less likely to be receiving nonsteroidal antiinflammatory drugs. After adjustments for age and sex, moderate hyperuricemia (serum UA >6.8 to ≤8 mg/dl) was associated with an increased risk of CVD-related mortality (hazard ratio 1.56 [95% confidence interval 1.11-2.21]). This association was attenuated and not significant following additional adjustment for comorbidities that more commonly accompany hyperuricemia. Results corresponding with serum UA concentrations of >8.0 mg/dl were similar, although not reaching statistical significance in any model. There were no associations of baseline serum UA concentration with all-cause mortality. Our study reports the frequency of hyperuricemia and gout in patients with RA. These results demonstrate strong associations of hyperuricemia with CVD mortality in this population, a risk that appears to be driven by excess comorbidity.

Osteoporosis in patients with rheumatoid arthritis: trends in the German National Database 2007\u20132017

Osteoporosis is a frequent comorbidity in rheumatoid arthritis (RA). Due to the improved treatment options for RA, we expect a long-term decrease in osteoporosis as an accompanying disease. Data from the German National Database (NDB) were used to investigate whether the frequency of osteoporosis has changed in the last 10 years. From 2007 to 2017, approximately 4000 patients were documented annually with data on therapy and comorbidity. The cross-sectional data were summarised descriptively. Age, sex, disease duration, disease activity and glucocorticoids were considered as influencing factors. The Cochrane-Armitage test for trend was used to test whether the frequency of osteoporosis at the first visit changed from 2007 to 2017. Osteoporosis frequency in RA patients (mean age 63 years, 75% female) decreased from 20% in 2007 to 6% in 2017 (p < 0.001). The decrease affected women (22% to 17%) and men (14% to 8%) in all age groups and both short-term (≤ 2-year disease duration: 9% to 3%) and long-term RA patients (> 10-year disease duration: 28% to 20%). Patients with high disease activity and patients who took glucocorticoids (GC) were more often affected by osteoporosis than patients in remission or without GC. Drug prophylaxis in patients without osteoporosis increased (20% to 41% without GC, 48% to 55% with GC). Men with GC received less prophylactic treatment than women (48% vs. 57% in 2017). In this cohort, osteoporosis in patients with RA is less frequently observed compared to former years. RA-specific risk factors for osteoporosis such as disease activity and GC therapy have declined but long-term GC use is still present. Assessment of osteoporosis in RA patients should be investigated more consistently by bone density measurement. Male RA patients still need to be given greater consideration regarding osteoporosis drug prophylaxis, especially when GC therapy is needed.

P238 RA and multimorbidity in UK Biobank: association with all-cause mortality and major adverse cardiac events

Abstract Background Multimorbidity, the presence of ≥ 2 long-term conditions (LTCs) is common in people with rheumatoid arthritis (RA). However, most research in RA has focused on cardiovascular disease and depression as co-occurring morbidities, rather than multiple LTCs or a wide range of conditions. This study hypothesised that risk of all-cause mortality and major adverse cardiac events (MACE) would be greater in those with RA and ≥2 LTCs than those with RA only. Further, we explored which individual LTCs were associated with increased risk of mortality and MACE. Methods Data from UK Biobank, a cohort of over 500,000 adults aged 37-73 years across England, Scotland and Wales was analysed. RA and 42 other LTCs of interest were self-reported by participants in a questionnaire and nurse-led interview. Information on sociodemographic (age, gender, socioeconomic status) and lifestyle factors (smoking status, BMI, alcohol frequency, physical activity) were also gathered. Rheumatoid factor levels were also determined. MACE and mortality were classified using linked hospitalisations and mortality register data (median follow up time 9 years). Data were analysed using age-adjusted Cox’s proportional hazard modelling to calculate risk of all-cause mortality or MACE, adjusted for variables listed above. Predictor variable: no RA no LTCs (reference group), only RA, RA + 1-3LTCs, RA + ≥4LTCs. Finally, the relationship between comorbidity with individual LTCs (of the 42 studied) and both health outcomes was considered. Results 5,658 (1.1%) of participants in UK Biobank self-reported RA (69.8% female, mean age 59 years). 74.7% of participants reported at least one LTC in addition to RA (1-3 LTCs 64.3%, ≥4 LTCs 10.4%), compared to 63.8% of participants without RA. 7.7% (N = 437) of participants with RA died and 5.9% (n = 331) had MACE events during the follow-up period. There was a dose response relationship in RA between LTC category and all-cause mortality and MACE risk. Only RA: mortality HR 1.42, 95% CI 1.08, 1.87, MACE HR 1.61 95% CI 1.20, 2.18; RA + 1-3LTCs: mortality HR 1.99 95% CI 1.74, 2.27, MACE HR 1.89, 95% CI 1.61, 2.20; RA + ≥4LTCs: mortality HR 3.34, 95% CI 2.64, 4.22; MACE HR 3.45, 95% CI 2.66, 4.49) compared to those with no RA no LTCs (results presented from fully adjusted models). Of the 42 individual LTCs considered, comorbid osteoporosis was the most concerning; participants with both RA and osteoporosis had a two-fold increased risk of all-cause mortality (HR 2.20, 95% CI 1.55, 3.12) and three-fold increased risk of MACE outcomes (HR 3.17, 95% CI 2.17, 4.64) compared to those with neither condition. Conclusion Participants with RA and multimorbidity or comorbidity, particularly osteoporosis, are at increased risk of adverse health outcomes. These results have important clinical relevance for the monitoring and optimal management of RA across the healthcare system. Disclosures B. Nicholl None. R. McQueenie None. B. Jani None. S. Macdonald None. C. McCowan None. J. Canning None. F. Mair None. S. Siebert None.

The Utility of Radiographic Focal Erosions of Hands or Feet in Predicting DXA-defined Osteoporosis of the Hip in Patients with Rheumatoid Arthritis.

Osteoporosis is a common comorbidity in Rheumatoid Arthritis (RA) patients and can result in estimated double risk of pathological fractures. Bone Mineral Density (BMD) is known to decrease with RA because of mechanisms incorporating traditional as well as disease-specific causes. With the advent of newer disease-modifying antirheumatic agents and bone protection medications, it is becoming important to identify those individuals who are at increased risk of developing osteoporosis among RA patients. In the current study, we aim to evaluate a multitude of factors including focal erosions on radiographs of hands or feet that can predict osteoporosis in RA patients. After obtaining IRB approval, 26 patients (20 females & 6 males) with a median age of 62 years (95% CI: 57.4 - 66.0) were retrospectively identified from a Rheumatology clinic database with an established diagnosis of RA but not taking osteoporosis medications. A detailed assessment was accomplished including evaluating a number of disease-specific variables, hands/feet radiographs and Dual-energy X-ray Absorptiometry (DXA). The total hip BMD was lower in RA patients with radiographic erosions (0.862 g/cm2 ± 0.17) compared to those patients without erosions (1.011 g/cm2 ± 0.13). On univariate logistic regression, the presence of radiographic erosions predicted osteoporosis of the hip (p = 0.04). ROC curve demonstrated satisfactory performance of erosions in predicting WHO-defined osteoporosis or osteopenia at the hip (AUC = 0.732). RA patients who show radiographic erosions are more likely to develop hip osteoporosis that may require further intervention.

РАСПРОСТРАНЕННОСТЬ ПОРАЖЕНИЯ ЩИТОВИДНОЙ ЖЕЛЕЗЫ У БОЛЬНЫХ РЕВМАТОИДНЫМ АРТРИТОМ, ПРОЖИВАЮЩИХ НА ЮГЕ КЫРГЫЗСТАНА

Rheumatoid arthritis (RA) is one of the most relevant but less studied medical and social problem of Kyrgyzstan. According to latest research of WHO, published in 2017, Kyrgyzstan is ranked second among world countries by rheumatoid arthritis-caused death rate. It is estimated, that autoimmune thyroiditis, hypothyroidism and thyrotoxicosis are associated comorbidities of rheumatoid arthritis. In Kyrgyzstan the autoimmune thyroiditis is ranked as second (8.9%) among the all thyroid diseases rate and considered to be the most frequent cause of hypothyroidism (7.2%). Meanwhile the thyrotoxicosis has been found in 6% of population, being on the fourth rank. The article shows the prevalence of thyroid pathology and its common nosological forms in patients with RA living in south of Kyrgyzstan, evaluates its association to rheumatoid arthritis’ activity. In RA patients the prevalence of autoimmune thyroiditis was found 12,6%, hypothyroidism (14,2)% (subclinical 13,0%, manifested in 1,2%), thyrotoxicosis in 1,2% cases.

Management and Comorbidities in Middle-European Patients with Rheumatoid Arthritis: A Retrospective, Cross-sectional Comparison with COMORA Data

Objective: To assess disease-specific characteristics and comorbidities in consecutive Middle-European Rheumatoid Arthritis (RA) patients, and to compare results with international data. Methods: Cross-sectional retrospective analysis of consecutive RA patients from a Middle-European outpatient service. Data are compared to those of the international “Co-morbidity in Rheumatoid Arthritis” (COMORA) cohort. Results: 80 RA patients with mean disease duration of 10.6 ± 8.3 years were enrolled within 5 months. Age was 62 ± 13 years and 75% were female. The Middle-European cohort showed slightly lower disease activity than the Austrian COMORA subcohort. 88.8% of all Middle-European RA patients were in remission or had low disease activity. Despite comparable disease characteristics, the percentage of patients ever treated with biological disease-modifying antirheumatic drugs (bDMARDs) was lower in the middle-European cohort (36.3%) than in the Austrian subcohort of COMORA (59%), but similar to the international COMORA cohort (39%). More smokers were in the Austrian COMORA subcohort (48.0) than in the Middle-European (22.5%) and the COMORA cohort (13%). Hypertension (38.8%) and osteoporosis (30.0%) were the most frequent comorbidities. Conclusion: Comparison of RA patients from this Middle-European cohort with the Austrian COMORA subcohort showed less frequent use of bDMARDs during disease course – probably according to the local referral structure. 88.8% of the Middle-European RA-patients achieved the treat-to target-aim of remission or low disease activity.

Comorbidities As Risk Factors for Rheumatoid Arthritis and Their Accrual After Diagnosis

ObjectiveTo determine the prevalence of comorbidities in rheumatoid arthritis (RA), discover which comorbidities might predispose to developing RA, and identify which comorbidities are more likely to develop after RA. Patients and MethodsWe performed a case-control study using a single-center biobank, identifying 821 cases of RA (143 incident RA) between January 1, 2009, and February 28, 2018, defined as 2 diagnosis codes plus a disease-modifying antirheumatic drug. We matched each case to 3 controls based on age and sex. Participants self-reported the presence and onset of 74 comorbidities. Logistic regression models adjusted for race, body mass index, education, smoking, and Charlson comorbidity index. ResultsAfter adjustment for confounders and multiple comparisons, 11 comorbidities were associated with RA, including epilepsy (odds ratio [OR], 2.13; P=.009), obstructive sleep apnea (OR, 1.49; P=.001), and pulmonary fibrosis (OR, 4.63; P<.001), but cancer was not. Inflammatory bowel disease (OR, 3.82; P<.001), type 1 diabetes (OR, 3.07; P=.01), and venous thromboembolism (VTE; OR, 1.80; P<.001) occurred more often before RA diagnosis compared with controls. In contrast, myocardial infarction (OR, 3.09; P<.001) and VTE (OR, 1.84; P<.001) occurred more often after RA diagnosis compared with controls. Analyses restricted to incident RA cases and their matched controls mirrored these results. ConclusionInflammatory bowel disease, type 1 diabetes, and VTE might predispose to RA development, whereas cardiovascular disease, VTE, and obstructive sleep apnea can result from RA. These findings have important implications for RA pathogenesis, early detection, and recommended screening.