Comparisons between comorbid conditions and health care consumption in rheumatoid arthritis patients with or without biological disease-modifying anti-rheumatic drugs: a register-based study

Abstract

BackgroundSymptoms and prognosis of patients with rheumatoid arthritis (RA) have improved with more intensive therapy, including the biological disease-modifying anti-rheumatic drugs (bDMARDs). Real life data concerning how comorbidities are distributed among patients treated or not treated with bDMARDs are scarce. Our objective was to investigate differences in comorbidity and health care consumption in RA patients, with and without bDMARDs.MethodsThis cross-sectional study was performed in the Southwestern part of Sweden. Patients, aged ≥ 18 years and diagnosed with RA in secondary health care during 2009–2010, were identified in the regional health care database. Aggregated data of comorbidity and health care consumption were retrieved between 2006 and 2010. RA patients treated with bDMARDs on 31st December 2010 were identified in the Swedish Rheumatology Quality Register (SRQ), which includes the biologics register Anti-Rheumatic Therapy in Sweden (ARTIS). Descriptive, comparative, univariate and multiple logistic regression analyses were used to identify factors associated with bDMARDs.ResultsSeven thousand seven hundred and twelve (7712) RA patients were identified (age 64.8 ± 14.9 years, women 74.3%), of whom 1137 (14.7%) were treated with bDMARDs. Overall, the most common comorbidities were infections (69.2%), hypertension (41.1%), chronic respiratory disease (15.3%), ischemic heart disease (14.0%) and malignancy (13.7%). Patients without bDMARDs were older and had more comorbidity. In the multiple logistic regression analysis, older age, cerebrovascular and chronic respiratory disease, heart failure, depression and malignancy were all associated with no present bDMARDs. Infections were associated with bDMARDs. Patients treated with bDMARDs consumed more secondary outpatient care but less visits in primary health care compared to patients without bDMARDs.ConclusionsPatients treated with bDMARDs versus no bDMARDs were younger and had significantly lower period prevalence for most common comorbidities, with the exception of infections. Differences in comorbidities between RA patients with or without bDMARDs should be taken into consideration when evaluating effectiveness and safety of bDMARDs in ordinary care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1354-7) contains supplementary material, which is available to authorized users.

Starting of biological disease modifying antirheumatic drugs may be postponed in rheumatoid arthritis patients with multimorbidity

“…[ 5 ] On the other hand, 2 prior studies encounter that more male patients frequently have more comorbidities among RA patients. [ 2 , 21 ] This conclusion is incompatible with our study.…”

Clinical management of patients with rheumatoid arthritis during the COVID-19 pandemic

“…Interpretation of these findings should be cautious. Because of the design of the studies, it is not possible to conclude if these observations could be attributable to a protective effect of bDMARDs or, instead, to a higher prevalence of risk factors (such as older age and multiple comorbidities) in patients not receiving DMARDs [34]. Moreover, patients receiving these treatments need strict follow up at rheumatology clinics and, therefore, it is easier to identify mild cases of viral infection.…”

The association between comorbidities and disease activity in patients with rheumatoid arthritis: a multicenter, cross-sectional cohort study in Japan with the highest proportion of elderly individuals

“…Another possible interpretation is that patients with a history of cerebrovascular disease are not being treated appropriately. In fact, the physical limitations of patients have been reported to be barriers to achieving optimal disease activity [18], and the usage rate of biologics has been reported to be lower in patients with cerebrovascular disease because this comorbidity is attributed to increased fragility [28]. In this study as well, a high Steinbrocker class was a risk factor for high disease activity in the multivariate logistic regression analysis; impaired physical function was associated with high disease activity.…”