Association between Rheumatic Disease Comorbidity Index and factors of poor prognosis in a cohort of 280 patients with rheumatoid arthritis

Abstract

Background Rheumatoid arthritis (RA) is commonly associated with higher rates of comorbidities. Recent recommendations highlight screening comorbidities during the disease course because of their impact on patients’ ability to function, on disease outcome, but also on treatment choices. Hence the interest of our study that aimed to quantify the impact of comorbidities among RA patients using a validated tool the Rheumatic Disease Comorbidity Index (RDCI) and to explore the association between comorbidities and disease characteristics. Methods We conducted a cross-sectional study over 12 months period, including patients followed for an established RA according to the ACR/EULAR 2010 criteria and hospitalized in our rheumatology department. Patients’ characteristics and disease features were collected for each patient. Comorbidities were quantified using the RDCI. We looked for the association between RDCI and patients characteristics and RA parameters. Univariable and multivariable analysis were made. Results They were 280 patients: 233 female (83.2%) and 47 male (16.8%) with a mean age of 58.07 (SD 11.12) years. The mean follow-up period was 14.74 (SD 1.63) years. Comorbidities were noted in 133 patients (47.5%). The mean comorbidity score measured by the RDCI was 1.05 (SD 1.23). RDCI was positively correlated with age (p < 0.001, r = 0.359). RA patients whose age of disease onset exceeds 40 years have significantly higher RDCI (1.8 (SD 1.3) [CI 95%: 1.36–1.88] vs. 1.5 (SD 1.2), p = 0.007). Moreover, RDCI was significantly associated with the presence pulmonary involvement (p < 0.001) and ocular involvement (p = 0.002). RDCI was also associated with erosive RA (p = 0.006), the presence of atlanto-axial dislocation (p = 0.014), and coxitis (p = 0.029). Regarding therapy regimen, RDCI was statistically increased in patients receiving bDMARDs compared to patients under csDMARDs (2.8 (SD 1.6) vs. 1.0 (SD 1.0), p = 0.021). Conclusion In this study, comorbidity index was associated with signs of poor prognosis such as erosions, coxitis, and atlanto-axial dislocation. This confirmed the hypothesis that comorbidity can be a threat to the improvement in the long-term prognosis in RA patients.

Investigating the Influence of Patient Eligibility Characteristics on the Number of Deferrable Rheumatologist Visits: Planning for a Patient-Initiated Follow-Up Strategy

“…Our study explores the effect of comorbidity burden, using the RDCI 24 as a criterion for PIFU inclusion. We selected the RDCI given evidence that the total burden of comorbidities is associated with worse RA outcomes [34][35][36][37] and increased mortality. 38,39 Conversely, well-managed comorbidities, such as hypertension or diabetes, may not add significant specialist care complexity as these are managed in primary care.…”

Updating and Validating the Rheumatic Disease Comorbidity Index to Incorporate ICD‐10‐CM Diagnostic Codes

“…Comorbidity burden is a crucial determinant of long-term outcomes that include death and functional status among individuals with rheumatic diseases (3,22,(29)(30)(31). Thus, we tested the validity of the ICD-10-CM codes by assessing the ability of the RDCI score to predict death and functional status.…”

Efficacy and Safety of Upadacitinib in Rheumatoid Arthritis: Real-Life Experience from a Prospective Longitudinal Multicentric Study

“…Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by progressive joint damage as well as extra-articular features responsible for several comorbidities [1].…”

“…Therefore, it carries severe effects on the overall quality of life and leads to a high socio-economic burden. Safe and effective long-term treatments are needed to reduce disease symptoms, prevent irreversible joint damage, and reduce the burden of the disease related to its comorbidities [1,3].…”