FRI0603-HPR COMORBIDITIES IN RHEUMATOID ARTHRITIS: UTILITY OF RACI SCORE (RHEUMATOID ARTHRITIS COMORBIDITY INDEX)
Authors: Y. Soria Curi, L. Gonzalez Lucero, F. J. Hüttmann, M. L. Leguizamón, S. M. Mazza, G. V. Espasa, A. L. Barbaglia, M. C. Bertolaccini, H. R. Sueldo, M. D. L. P. León, P. R. Maldonado, V. I. Bellomio
Journal: Annals of the Rheumatic Diseases (2020)

Background: One third of patients with rheumatoid arthritis have some comorbidity at the time of diagnosis and 80% during the evolution. The presence of each additional comorbidity reduces the chances of remission by 28%. Objectives: To determine the prevalence of comorbidities in Rheumatoid Arthritis (RA) and to evaluate associated variables. Methods: A descriptive cross-sectional study was conducted. It were included patients over 18 years of age, who attended the Rheumatology office between May and August 2018 with a diagnosis of RA according to the ACR 1987 and ACR/EULAR 2010 criteria. Demographic variables were studied along with disease-related variables (time of evolution, disease activity by DAS-28 and CDAI, treatment and functional capacity (HAQ-A)). The presence of comorbidities was evaluated using two indexes: Rheumatoid Arthritis Comorbidity Index (RACI) and Disease Comorbidity Index (RDCI). RACI consists of 31 comorbidities grouped into 11 categories: DAS 28 &gt;3.6, local inflammation, smoking, tumors, systemic involvement, infection, vascular disease, bone health, mood, metabolic and cardiovascular disorders (score range 0-36). RDCI consists of 11 comorbidities (categories according to ICD-10) and a formula to calculate it (range 0-9). For both indexes; higher score, greater comorbidity. Results: In this cross-sectional study, 345 patients were evaluated, of which 176 were included, 85.8% of the patients were female and the mean age was 52.7 ± 10.9 years; 31.2% of the cases finished primary school, the median of disease duration was 9 years (1-40), the mean DAS28 3.8 ± 1.4, and the mean CDAI 12.4 ± 11.3. 52.3% of the patients received treatment with glucocorticoids, 60.8% with NSAID, 60.2% with methotrexate, 39.2% with leflunomide, 17.6% with biologic DMARds and 5.6% with tofacitinib. 90.3% of the patients (95% CI 84.8, 94.3) presented some comorbidity measured by RACI. The average score was 4.7 ± 3.4 and the most frequent comorbidity were: elevated DAS28 (40.9%), dyslipidemia (38.1%), AHT (36.4%), prednisone &gt;5 mg/d in 31.8%, endocrinopathies 19.3%. 73.3% of the patients had more than one comorbidity. Regarding RDCI, 47.2% of the cases presented some comorbidity with an average score of 0.95 ± 1.3; the most frequent were: AHT 36.4%, lung disease 12.5% and diabetes 8%. The oldest patients had more than one comorbidity (RACI), and also presented a higher HAQ score than those with only one (p&lt;0.0001). Higher RACI score was associated with higher CDAI (p&lt;0.001) and the use of glucocorticoids (p=0.008). Conclusion: The prevalence of comorbidities in RA by RACI was elevated (90.3%) and 73.3% of the patients presented more than one comorbidity. The patients with the highest RACI score had higher disease activity and used glucocorticoids more frequently. Disclosure of Interests: None declared