Comorbidities in Patients with Rheumatoid Arthritis and Their Association with Patient-reported Outcomes: Results of Claims Data Linked to Questionnaire Survey

Abstract

Objective.To investigate the prevalence of comorbidities in a population-based cohort of persons with rheumatoid arthritis (RA) compared to matched controls and to examine their association with patient-reported outcomes in a survey sample.Methods.Data of 96,921 persons with RA [International Classification of Diseases, 10th ed (ICD-10) M05/M06] and 484,605 age- and sex-matched controls without RA of a German statutory health fund were studied regarding 26 selected comorbidities (ICD-10). A self-reported questionnaire, comprising joint counts [(tender joint count (TJC), swollen joint count (SJC)], functional status (Hannover Functional Ability Questionnaire), effect of the disease (Rheumatoid Arthritis Impact of Disease), and well-being (World Health Organization 5-item Well-Being Index; WHO-5) was sent to a random sample of 6193 persons with RA, of whom 3184 responded. For respondents who confirmed their RA (n = 2535), associations between comorbidities and patient-reported outcomes were analyzed by multivariable linear regression.Results.Compared to controls, all investigated comorbidities were more frequent in persons with RA (mean age 63 yrs, 80% female). In addition to cardiovascular risk factors, the most common were osteoarthritis (44% vs 21%), depression (32% vs 20%), and osteoporosis (26% vs 9%). Among the survey respondents, 87% of those with 0–1 comorbidity but only 77% of those with ≥ 8 comorbidities were treated by rheumatologists. Increasing numbers of comorbidities were associated with poorer values for TJC, SJC, function, and WHO-5.Conclusion.Compared to a matched population, persons with RA present with increased prevalence of numerous comorbidities. Patients with RA and multimorbidity are at risk of insufficient rheumatological care and poorer patient-reported outcomes.

Long-term trends in rheumatology care

“…On the other hand, there are large deviations, e.g. in the degree of DMARD care, which is much higher for rheumatologists in the NDB than in the claims data [28] or in the prevalence of co-morbidity diagnoses [29], which are significantly more frequent in the claims data than in the NDB. Since itis notpossible torule outinsufficient reporting in the NDB as well as over-reporting in insurance data, the authors estimate the information provided by rheumatologists on concomitant diseases in the NDB to be somewhat too low and the claims diagnoses in the insurance data to be somewhat too high.…”

Reality of care for musculoskeletal diseases at the population level

“…A particular strength of the PROCLAIR project was therefore the availability of data on people who are not in rheumatological care, but who are treated exclusively by general practitioners or another specialist. The evaluation of comorbidity in RA patients showed that individuals with many comorbidities are less frequently treated by a specialist [14] than individuals with few comorbidities. It could be that in view of the multitude of necessary measures and medications the coordinating function of the general practitioner gains priority.…”

“…Provision of health services [4] Comorbidity [14] Physical therapy [9] Income and burden of disease [6] Depressive symptoms and burden of disease [19] Diagnostic delay [18] Provision of health services Extra-articular manifestations Comorbidity The claims data were analysed not only for the PROCLAIR respondents (linking claims and survey data), but also for all insured persons who had one of the three diagnostic codes. Therefore, some analyses refer to the total data set of BARMER insurants (e.g.…”

“…All diagnoses and prescribed medications are recorded in health insurance data. In the overall data set, Ramos et al [14] compared the prevalence of concomitant diseases in insured persons with RA diagnosis (defined as ICD-10 coding of M05 or M06 in at least two quarters in 2013) with an age-and gender-matched control group without RA. All comorbidities considered were more frequent in RA.…”

Chronic pain and central sensitization in immuno-inflammatory rheumatic diseases: pathogenesis, clinical manifestations, the possibility of using targeted disease modifying antirheumatic drugs

“…Совсем недавно А. Luque Ramos и соавт. [65] представили данные анализа коморбидной патологии у 96 921 больного РА (жители Германии). Признаки депрессии были выявлены у 32% опрошенных пациентов, в то время как в контрольной группе (484 605 условно здоровых жителей) лишь у 20%, т. е. почти в 1,5 раза меньше.…”