EP16 The impact of comorbidities on individuals with inflammatory arthritis
Authors: Koduri Gouri M , Gullick Nicola , Hayes Fiona , Kayani Abdul , Dubey Shirish , Mukhtyar Chetan 
Published: April 2020

Abstract

Background
Inflammatory arthritis (IA) predisposes to comorbidities (CC) including cardiovascular disease, osteoporosis, depression, infections, and cancer. CC are associated with higher mortality, poorer quality of life, and greater utilisation of health resources. Treating CC can be challenging and their impact is not addressed by current guidelines. The patient’s perspective of living with multiple conditions remains largely unexplored. We explored patient experience, impact of CC and polypharmacy on their quality of life and activities of daily living.

Methods
A mixed methods approach has been used. Patients with a definite diagnosis of IA with at least 1 Charlson comorbidity were invited to answer questionnaires. A sample of patients was invited for an in-depth qualitative interview which was analysed using thematic analysis approach.

Results
146 patients from 3 centres were recruited. 82 (56%) were females. 58 (40%) had 1 CC, 62 (42.5%) had ≥2 CC, 21 (14.5%) had ≥4 CC. Most common CC was hypertension 76 (53%), pulmonary disease 49 (34%), and diabetes 34 (23.5%). 28 (19%) remained in full time employment and 19 (13%) were unemployed. 27 (18.5%) had to cut down hours because of illness. Disease duration was &gt;10 years in 74 (51%), 5-10 years in 29 (20%), 3- 5 yrs in 21 (14%) and &lt;3 years in 22 (15%). Self-rated severity of disease was rated as low (26%), moderate (42%), severe (24%) and very severe (5.5%). Awareness and impact of CC: 77 (53%) expressed that CC affected their health as much as their arthritis. No information on CC was provided in 27 (18%), minimal information in 35 (24%) and detailed information 69 (47%). 68 (47%) were aware that some of the comorbidities could be the result of the disease or medications and 72 (49%) weren’t aware. 82 (56%) needed help from their family members/carers and of those 30% needed help daily due to CC. Polypharmacy: 73 (50%) stated either they were not involved or ‘just a little’ in choice of medication. 23 (15%) needed medication for side effects. 116 (79%) stated that doctors discuss the risks and benefits at follow ups. 130 (89%) take arthritis and CC related medication regularly. Lifestyle advice: 106 (73%) stated that education on CC wasn’t offered. 24 (16%) were not offered smoking cessation and 32 (22%) declined smoking cessation clinics. 43 (30%) weren’t aware that obesity could cause joint pains or increase the risk of diabetes, hypertension or IHD. 95 (65%) said advice on benefits of exercise was provided. Light exercises such as walking for minimum of 30 minutes was undertaken by 75%: reasons for not exercising were pain, fatigue, lack of motivation, low morale and CC.

Conclusion
This novel study provides insight into patient experiences of understanding comorbidities in the context of inflammatory arthritis. CC have a large impact on their lives and current care does not adequately meet their needs with respect to education of CC, understanding the impact, shared decision-making and lifestyle advice.

Disclosures
G.M. Koduri Honoraria; Roche. Grants/research support; Funding from Charity. N. Gullick None. F. Hayes None. A. Kayani None. S. Dubey None. C. Mukhtyar None.