Multimorbidity in rheumatic conditions

Radner, Helga

doi:10.1007/s00508-016-1090-x

Cited by 37 publications

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“…In addition, rheumatoid pneumonia (RhPn), furthermore interstitial pneumonia (IPn) [1][2][3][4] were determined at autopsy and confirmed in a detailed review of extensive histological material. The possible role of AAa on the prevalence of purBr or BrPn, InfPn, OcclPn, RhPn and IPn was analyzed with Pearson's chi-squared (c 2 ) test.…”

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Fri0025 does Comorbidity Impact on the Activity and Management of Rheumatoid Arthritis?

Бабаева

Kalinina

Zvonorenko

et al. 2019

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Background:Patients with rheumatoid arthritis (RA) are in increased risk of developing comorbid conditions. Recent data suggest the relationship between severity of RA and concomitant diseases [1, 2]. Drug therapy is considered as impotent risk factor for numerous comorbidities. On the other hand comorbidity can impact negatively on the RA course and on the pts management [3].Objectives:The aim of our study was to evaluate the prevalence of concomitant conditions in RA pts, to compare the RA activity and management in relation with comorbidities.Methods:168 pts with established and longstanding RA were observed at in-patient clinic for RA clinical assessment and revealing concomitant diseases (cardiovascular, gastrointestinal, liver, pulmonary, endocrine, blood). The activity of disease according to DAS28-ESR index in RA subgroups with different comorbidities was compared. The spectrum and used doses of anti-rheumatic medications (DMARD, biologics, GC) in these subgroups was analyzed in term to assess the RA rational treatment.Results:The majority (88.1%) of observed RA pts had concomitant condition. The most frequent associated diseases were: cardiovascular (AH, IHD, HF, AF) in 86.9% and gastrointestinal (gastritis, duodenitis, gastroduodenal ulcer, colitis) in 64.3% less common comorbidities were anemia (30.9%), liver and kidney abnormalities (hepatomegaly, steatohepatitis, CKD, pyelonephritis) in 25% and 12.5% respectively, endocrine (type 2 diabetes mellitus, thyroid disorders) in 16.7%. Multimorbidity determined as combination of different system disorders in the setting of RA was detected in 54.8% of RA pts. We found out significant difference in RA activity on the basis of DAS28 between RA subgroup without concomitant conditions (the 1st) on the one hand and RA subgroups with comorbidities (the 2nd) (t1=2.76, p<0.01) or multimorbidities (t2=3.73, p<0.01) on the other hand (tab.1).IndexRA without comorbidities (1stgroup)RA with comorbidities(2nd group)RA with multimorbidities(3d group)DAS 284.20 ±0.315.09±0.095.44±0.12In RA with comorbidities/multimorbidities the mean doses of MTX and SSZ were lower than in RA without comorbidities, while the dose of GC and frequency of GC use was significantly higher in the 2nd and 3d groups (χ=4.25, 4.41 respectively). 55% of pts from the 1st group and only 19.6% of total amount of pts from the 2nd and 3d groups were treated with biologics (χ=5.67).Conclusion:Obtained data suggest that comorbidities have a negative impact on the severity of RA and can interfere in the implementation of T2T strategy in daily clinical practice.References:[1] Dougados M, Soubrier M, Antunez A, Balint P, Balsa A, Buch MH, et al. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis (2014) 73(1):62–8. doi:10.1136/annrheumdis-2013-204223[2] Radner H. Multimorbidity in rheumatic conditions. Wien Klin Wochenschr (2016) 128(21–22):786–90. doi:10.1007/s00508-016-1090-x[3] Radner H, Yoshida K,...

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“…Recent data suggest the relationship between severity of RA and concomitant diseases [1,2]. Drug therapy is considered as impotent risk factor for numerous comorbidities.…”

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confidence: 99%

Fri0025 does Comorbidity Impact on the Activity and Management of Rheumatoid Arthritis?

Бабаева

Kalinina

Zvonorenko

et al. 2019

Poster Presentations

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“…PON1 is a lipoprotein-derived enzyme which provides antioxidant properties of HDL. Although MPO is a bactericidal enzyme derived from granular leukocytes, it causes oxidative modification of circulating lipoproteins [2]. Objectives: The aim of this study is to evaluate the levels of dysfunctional HDL in RA patients and to explore the relationship between dysfunctional HDL and coronary artery disease (CAD) in RA patients.…”

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confidence: 99%

“…The prevalence of AAa and of distinctly different forms of multifocal inflammation, such as purulent bronchitis and bronchiolitis (purBr) or bronchopneumonia (BrPn), infarct with pneumonia (InfPn), occlusive pneumonia (OcclPnfocal pneumonia caused by compressive peribronchial nodular lymphoid hyperplasia or bronchial blockage by a necrotic nodule) were examined. In addition, rheumatoid pneumonia (RhPn), furthermore interstitial pneumonia (IPn) [1][2][3][4] were determined at autopsy and confirmed in a detailed review of extensive histological material. Background: Patients with rheumatoid arthritis (RA) are in increased risk of developing comorbid conditions.…”

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Fri0024 aa Amyloidosis and Lung Diseases in Rheumatoid Arthritis – A Postmortem Clinicopathologic Study of 147 Patients

Apáthy

Bély²

2019

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BackgroundSystemic AA amyloidosis (AAa) is one of the most important complications of rheumatoid arthritis (RA) [1].A wide spectrum of lung diseases may complicate RA or associate with RA [2-4].ObjectivesThe aim of this study was to determine the influence of AAa on lung diseases related or not related to RA.MethodsWe studied 161 random autopsy patients with RA [1]. RA was confirmed clinically according to the criteria of the ARA [5]. Tissue samples of the lungs were available for histological evaluation of 147 patients.The prevalence of AAa and of distinctly different forms of multifocal inflammation, such as purulent bronchitis and bronchiolitis (purBr) or bronchopneumonia (BrPn), infarct with pneumonia (InfPn), occlusive pneumonia (OcclPn – focal pneumonia caused by compressive peribronchial nodular lymphoid hyperplasia or bronchial blockage by a necrotic nodule) were examined. In addition, rheumatoid pneumonia (RhPn), furthermore interstitial pneumonia (IPn) [1-4] were determined at autopsy and confirmed in a detailed review of extensive histological material.The possible role of AAa on the prevalence of purBr or BrPn, InfPn, OcclPn, RhPn and IPn was analyzed with Pearson’s chi-squared (χ 2) test.Results AAa complicated RA in 34 (23.13%) of 147 patients. Pulmonary blood vessels of different caliber and various tissue structures of the lungs were involved in 25 (73.53% of 34) cases; the lungs were not involved by AAa in 9 (26.47% of 34) cases. purBr or BrPn were associated with RA in 19 (21.1%), InfPn in 5 (3.4%), OcclPn in 2 (1.4%), RhPn in 3 (2.1%) of 147 patients (only the fatal cases were considered). IPn – characterized by interstitial cellular infiltration with or without edema, fibrinoid deposition, with or without fibrosis, and with or without corresponding pleuritis was present in 35 (23.8%) of 147 patients; IPn alone was not fatal in our cohort and contributed to the death only in association with cardiac, circulatory or cardio-respiratory insufficiency.Pulmonary amyloid A deposition (n=25) was associated with purBr or BrPn in 1 (5.26%) of 19, InfPn in 1 (20.0%) of 5, OcclPn in 2 (100.0%) of 2, RhPn in none (0.0%) of 3, IPn in 12 (34.29%) of 35 patients.The relationship between pulmonary AAa and purBr or BrPn (χ=1.2836, p<0.25), InPn (χ=0.1800, p<0.67) or RhPn (χ=0.00025, p<0.98) was not significant. There was a significant and positive correlation between pulmonary AAa and OcclPn (χ=4.8313, p<0.02) or between AAa and lPn (χ=9.7106, p<0.0018).ConclusionThe main complications of RA, such as AAa, may influence the prevalence, clinical course and symptoms of associated diseases and vice versa. Knowledge of these relationships is important to estimate the relative danger they potentially represent.The significant correlation between AAa and OcclPn or IPn suggests a positive influence of pulmonary amyloid A deposition on OcclPn or lPn. The statistically not significant correlations suggest that purBr or BrPn, InPn and RhPn are independent entities which are not influenced by AAa.References[1] Bély M, Apáth...

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“…Due to their high incidence and low case-fatality, RMDs frequently co-exist with other conditions, a phenomenon known as multimorbidity [10]. Multimorbidity poses a technical challenge when the aim is to disentangle and estimate the comparative burden of RMDs in the context of all NCDs in the population.…”

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The population impact of rheumatic and musculoskeletal diseases in relation to other non-communicable disorders: comparing two estimation approaches

et al. 2018

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The aim of this study was to quantify the population impact of rheumatic and musculoskeletal diseases (RMDs) with other non-communicable diseases (NCDs), using two complementary strategies: standard multivariate models based on global burden of disease (GBD)-defined groups vs. empirical mutually exclusive patterns of NCDs. We used cross-sectional data from the Portuguese Fourth National Health Survey (n = 23,752). Six GBD-defined groups were included: RMDs, chronic obstructive pulmonary disease or asthma, cancer, depression, diabetes or renal failure, and stroke or myocardial infarction. The empirical approach comprised the patterns "low disease probability", "cardiometabolic conditions", "respiratory conditions" and "RMDs and depression". As recommended by the outcome measures in rheumatology (OMERACT) initiative, health outcomes included life impact, pathophysiological manifestations, and resource use indicators. Population attributable fractions (PAF) were computed for each outcome and bootstrap confidence intervals (95% CI) were estimated. Among GBDdefined groups, RMDs had the highest impact across all the adverse health outcomes, from frequent healthcare utilization (PAF 7.8%, 95% CI 6.2-9.3) to negative self-rated health (PAF 18.1%,). In the empirical approach, patterns "cardiometabolic conditions" and "RMDs and depression" had similar PAF estimates across all adverse health outcomes, but "RMDs and depression" showed significantly higher impact on chronic pain (PAF 8.9%, 95% CI 7.6-10.3) than the remaining multimorbidity patterns. RMDs revealed the greatest population impact across all adverse health outcomes tested, using both approaches. Empirical patterns are particularly interesting to evaluate the impact of RMDs in the context of their co-occurrence with other NCDs.

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Multimorbidity in rheumatic conditions

Cited by 37 publications

References 53 publications

Fri0025 does Comorbidity Impact on the Activity and Management of Rheumatoid Arthritis?

Fri0025 does Comorbidity Impact on the Activity and Management of Rheumatoid Arthritis?

Fri0024 aa Amyloidosis and Lung Diseases in Rheumatoid Arthritis – A Postmortem Clinicopathologic Study of 147 Patients

The population impact of rheumatic and musculoskeletal diseases in relation to other non-communicable disorders: comparing two estimation approaches

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