Christian Mallen c.d.mallen@keele.ac.uk
Prognostic value of comorbidity indices and lung diseases in early rheumatoid arthritis: a UK population-based study
Mallen
Authors
Abstract
We assessed comorbidity burden in people with RA at diagnosis and early disease (3 years) and its association with early mortality and joint destruction. The association between lung disease and mortality in RA is not well studied; we also explored this relationship.From a contemporary UK-based population (n = 1, 475 762) we identified a cohort with incident RA (n = 6591). The prevalence of comorbidities at diagnosis of RA and at 3 years was compared with age- and gender-matched controls (n = 6591). In individuals with RA we assessed the prognostic value of the Charlson Comorbidity Index and Rheumatic Disease Comorbidity Index calculated at diagnosis for all-cause mortality and joint destruction (with joint surgery as a surrogate marker). We separately evaluated the association between individual lung diseases [chronic obstructive pulmonary disease (COPD), asthma and interstitial lung disease] and mortality.Respiratory disease, cardiovascular disease, stroke, diabetes, previous fracture and depression were more common (P < 0.05) in patients with RA at diagnosis than controls. Comorbidity (assessed using RDCI) was associated with all-cause mortality in RA [adjusted hazard ratio (HR) 1.26, 95% CI 1.00–1.60]. There was no association with joint destruction. COPD, but not asthma, was associated with mortality (COPD HR 2.84, 95% CI 1.13–7.12).There is an excess burden of comorbidity at diagnosis of RA including COPD, asthma and interstitial lung disease. COPD is a major predictor of early mortality in early RA. Early assessment of comorbidity including lung disease should form part of the routine management of RA patients.
Citation
Mallen. (2019). Prognostic value of comorbidity indices and lung diseases in early rheumatoid arthritis: a UK population-based study. Rheumatology, 1296-1305. https://doi.org/10.1093/rheumatology/kez409
Acceptance Date | Aug 8, 2019 |
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Publication Date | Oct 3, 2019 |
Journal | Rheumatology |
Print ISSN | 1462-0324 |
Publisher | Oxford University Press |
Pages | 1296-1305 |
DOI | https://doi.org/10.1093/rheumatology/kez409 |
Keywords | rheumatoid arthritis, mortality, joint damage, comorbidity, chronic obstructive pulmonary disease, asthma, cardiovascular diseases |
Publisher URL | https://doi.org/10.1093/rheumatology/kez409 |
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https://creativecommons.org/licenses/by-nc/4.0/