OP0214 Baseline comorbidities and overweight predict functional status and health-related quality of life 9 years later – a longitudinal cohort study of 428 patients with rheumatoid arthritisreceiving standard care
Authors: L. Linde, M.L. Hetland
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Health-related quality of life (HRQOL) and functional status are markedly reduced in patients with rheumatoid arthritis (RA) leading to a significant societal and individual burden. Comorbidities and sociodemographic factors are associated with reduced HRQOL and functional status in cross-sectional studies of RA,<sup><sup>1</sup></sup> but their predictive value is largely unknown as longitudinal studies are lacking. <h3>Objectives</h3> To investigate whether comorbidities and sociodemographic factors predict HRQOL and functional status 9 years later in real-world patients with RA. <h3>Methods</h3> Consecutive patients with RA were recruited from a university hospital outpatient clinic between <sup><sup>July 2006</sup></sup> and July 2007. Data regarding sex, age, disease duration, disease activity score of 28 joints and CRP (DAS28), number of comorbid conditions, marital status (married/cohabiting vs living alone), smoking (ever, previously or currently), exercise (≥once a week vs not regularly), body mass index (BMI), educational level (elementary, training or higher), functional status (the health assessment questionnaire (HAQ)) and HRQOL (Euroqol 5 dimensions (EQ-5D)) were registered in the clinical database DANBIO; patients then continued routine care. EQ-5D includes 5 dimensions of health (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), each divided into three levels of severity, yielding 243 possible health states. A validated algorithm converts each health state into an index score between 0 (death) and 1 (perfect health).<sup><sup>2</sup></sup> HAQ and EQ-5D scores at the most recent follow-up visit were retrieved from DANBIO on Sept 30th 2017. Two linear regression models were built with scores for HAQ and EQ-5D at follow-up as outcomes, respectively, all baseline variables were entered as possible explanatory variables and stepwise backward selection was employed. Sex, age, disease duration and baseline HAQ/EQ-5D were forced into the models. <h3>Results</h3> 564 patients with RA were recruited (81% women, median (IQR) age: 60<sup><sup>49–68</sup></sup> years, disease duration: 7 (3–16) years, DAS28: 2.9 (2.1–3.7), HAQ: 0.63 (0.25–1.25), EQ-5D: 0.74 (0.66–0.82) and followed in routine care for a median of 9<sup><sup>4–10</sup></sup> years. 428 and 256 patients had complete HAQ and EQ-5D scores, respectively at follow-up (HAQ: 0.75 (0.25–1.4), EQ-5D: 0.78 (0.69–0.86)). Patients without complete HAQ and EQ-5D scores at follow-up were older at baseline (10 and 6 years, respectively, p&lt;0.0001), while sex, disease duration, DAS28, HAQ and EQ-5D scores were similar. High HAQ, BMI 26–30 kg/m2, and 3 or more comorbid conditions at inclusion were all independently associated with poorer functional status and low EQ-5D 9 years later (table 1). The models with HAQ or EQ-5D as outcome explained 51% and 31% of the variation (Adj R<sup>2</sup>), respectively. <h3>Conclusions</h3> Potentially modifiable factors (overweight and comorbidities) were independently and consistently associated with worse functional status and HRQOL at follow-up 9 years later in patients with RA receiving standard care. The findings suggest that focus on lifestyle and comorbidities in patients with RA may improve important long-term outcomes. <h3>References</h3> [1] Linde L, et al. J Rheumatol2009;36(10):2183–2189. [2] Wittrup-Jensen K, et al. Scand J Public Health2009;00:1–8. <h3>Disclosure of Interest</h3> None declared