Secular Changes in Clinical Features at Presentation of Rheumatoid Arthritis: Increase in Comorbidity But Improved Inflammatory States

Abstract

Objective: To examine secular trends in demographic, clinical manifestations and comorbidity on first presentation of RA prior to DMARD treatment.Methods: 2701 patients were recruited over 25years to two UK-based RA inception cohorts:the Early RA Study (9 centres; 1986-2001) and the Early RA Network (23 centres; 2002-2012). Trends in demographic and baseline clinical/laboratory and radiographic variables and comorbidities were estimated using mixed effects models, including random effects for recruitment centre.Results: Age-at-onset increased from 53.2 to 57.7 years in 1990 and 2010 respectively (2.6 months/year; 95% CI 1.2-4.1). Gender-ratio, the proportion living in deprived areas and smoking status were unchanged (p>0.05) and there were no changes in the proportion seropositive or erosive at baseline (p>0.05). After controlling for treatment at the time of assessment, ESR reduced and haemoglobin increased over time (p<0.05), however HAQ, DAS, DAS28, and joint counts were unchanged (p>0.05). The overall prevalence of comorbidity increased from 29.0% in 1990 to 50.7% in 2010, mainly due to cardiovascular and non-cardiac vascular conditions including hypertension. There was a significant increase in BMI (0.15 units/year; 95% CI 0.11-0.18), resulting in an increase in the prevalence of obesity from 13.3% in 1990 to 33.6% in 2010.Conclusions: Age-at-onset and comorbidity burden, especially obesity have increased at RA presentation over 25 years, reflecting wider demographic trends at the population level. In contrast there were no accompanying changes in disease severity assessed by composite markers of disease activity, radiographic erosions, seropositivity or HAQ at presentation.Treatment strategies in early RA should take greater account of the impact of co-morbidity on outcomes.

Are we really what we eat? Nutrition and its role in the onset of rheumatoid arthritis

“…Co-morbidities in RA, aside from being increasingly prevalent at disease onset [21], add to the burden of disease over time and prevent the achievement of good treatment outcomes [22]. A good and recent example for the latter is the impact of a high body mass index (BMI) on treat-to-target goals in RA, emphasizing the importance of targeting obesity as part of the routine management of RA [23].…”

“…comorbidity even on first presentation of RA [21] and is a key determinant of insulin resistance, even more so than circulating proinflammatory cytokines [25].…”

Repercussions of adjuvant-induced arthritis on body composition, soleus muscle, and heart muscle of rats

“…The systemic manifestations of RA can occur in different organs and tissues (4,7). Changes in the total body mass, as well as in the masses of both skeletal and adipose tissue, are described in RA patients.…”

Recipients’ and providers’ perspectives of obesity and potential barriers to weight management programmes in patients with Rheumatoid Arthritis (RA): a qualitative study

“…Work by Nikiphorou et al (2016) on 2 large UK based RA inception cohorts, examined trends at first presentation of RA, including co-morbidities, and showed a significant increase in body mass index (0.15 units/year; 95% CI 0.11, 0.18), resulting in an increase in the prevalence of obesity at diagnosis from 13.3% in 1990 to 33.6% in 2010 [ 10 ].…”