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Cardiovascular Comorbidities Relate More than Others with Disease Activity in Rheumatoid Arthritis
Gloria Crepaldi1, Carlo Alberto Scirè2, Greta Carrara2
1Department of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
Insights
Cardiovascular comorbidities significantly impact rheumatoid arthritis (RA) disease activity. Diabetes is linked to higher RA activity, while hyperlipidemia is associated with lower activity, affecting patient outcomes.
Area of Science:
- Rheumatology
- Clinical Medicine
- Epidemiology
Background:
- Comorbidities are common in rheumatoid arthritis (RA) patients.
- Understanding their impact on disease activity is crucial for effective management.
Purpose of the Study:
- To investigate how various comorbidities influence clinical outcomes and disease activity in rheumatoid arthritis (RA).
Main Methods:
- A cross-sectional, observational, multicenter international study (COMORA) included 3,920 RA patients.
- Multivariable linear regression analyzed relationships between comorbidities and disease activity measures (e.g., DAS28, joint counts, ESR, global assessments).
Main Results:
- Diabetes was associated with increased swollen/tender joints and worse global assessments.
- Hyperlipidemia correlated with fewer swollen/tender joints, lower ESR, and better global assessments.
- Cardiovascular comorbidities, particularly diabetes and hyperlipidemia, significantly influenced the 28-Disease Activity Score (DAS28).
Conclusions:
- Cardiovascular comorbidities play a significant role in rheumatoid arthritis (RA) disease activity.
- Diabetes and hyperlipidemia show distinct associations with RA activity, highlighting their importance in assessment and management.
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.
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